Skin-brain axis: sleep, stress and dermatological health in over 1000 Chinese urban women

Objectives: To provide the first large-scale, real-world characterization of associations between sleep quality, perceived stress, and a comprehensive range of dermatological outcomes in healthy Chinese women. Introduction: Psychological stress and poor sleep quality are highly prevalent among urban adults in China, yet their dermatological consequences have not been characterized at scale under naturalistic conditions in this population. While neuro-endocrine-immune pathways linking psychosocial burden to skin, scalp, and hair health have been proposed, existing evidence derives largely from small or Western cohorts conducted under controlled settings. Materials / method: This cross-sectional observational study enrolled over 1,000 healthy women aged 18-40 years in Shanghai, China. Sleep quality and perceived stress were assessed using validated psychometric instruments. Dermatological outcomes were evaluated across self-perception surveys, expert clinical scoring, and objective instrumental measurements. Results: Poor sleep quality and elevated perceived stress were associated with a distinct and clinically meaningful pattern of dermatological concerns, spanning scalp sensitivity, skin fatigue appearance, perceived skin tone alteration, periorbital pigmentation, hair loss, etc. Age-stratified analyses identified poor sleep as a significant correlate of acne severity in the youngest participants. Conclusion: This study represents the first large-scale real-world investigation of sleep and perceived stress as determinants of skin, scalp, and hair health in a Chinese urban female population. Findings are consistent with the skin-brain axis framework and underscore the relevance of integrating psychosocial assessment into dermatological evaluation, positioning skin health not only as a localized concern but as a visible mirror of systemic health and longevity.