Lisa A. Swanson, MD

The Skin–Brain Axis: Emerging Evidence Transforming Dermatologic Care

Growing evidence suggests the brain and skin communicate more closely than previously understood, linking inflammatory skin disease to neurocognitive and emotional health outcomes.

 Investigators are now pointing to the skin–brain axis, a bidirectional pathway of neural, immune, and endocrine signals, as a key driver of both 

“There is a skin–brain connection,” Lisa A. Swanson, MD, a dual board-certified dermatologist and pediatric dermatologist at Ada West Dermatology, told 

The most clear area where we have evidence for that is with atopic dermatitis in little kids. We know that patients with bad atopic dermatitis tend to have increased rates of things like ADHD, anxiety, depression, learning disabilities, even autism spectrum disorder, and for years, we wondered why.”

 mouse model study found that elevated interleukin-4 (IL-4), a key cytokine in atopic inflammation, was associated with delayed cognition and decreased myelination.

 This finding points to a mechanistic overlap between inflammatory signaling and neural development.

In line with this discovery, clinical data now show that IL-4 inhibition with dupilumab may reduce the need for ADHD medication among children with atopic dermatitis. A retrospective cohort study of pediatric patients found that ADHD prescription rates dropped significantly after starting dupilumab.

“So, I think there is a brain skin connection, especially in the situation of atopic dermatitis,” Swanson said.

Mohammad Jaffarany, PhD, professor at Central Michigan University and president of the Association for Psychocutaneous Medicine of North America, said emerging research has helped explain how stress and mood disorders can trigger or exacerbate inflammatory flares.

“When there is any kind of stress due to whatever reason…our brain gets activated, and there [is] release of hormones—ACTH,” Jaffarany explained.

The brain triggers further activation of the sympathetic nervous system by influencing the adrenal cortex and increasing levels of adrenaline and norepinephrine. These hormones act on various cells, including immune cells, ultimately activating mast cells. Once activated, these mast cells release different chemical mediators, interleukins, and chemokines, which drive inflammation throughout the system.

“This has a core vicious circle,” Jaffarany said. “It goes on and on.”

Neurogenic inflammation has been observed in several dermatologic conditions, including psoriasis, prurigo nodularis, and rosacea.

 Patients frequently report discomfort even when visible inflammation is under control, suggesting a neurological component that may persist independently of skin barrier repair.

Enzo Berardesca, MD, a professor from Miami Miller School of Medicine, investigated a topical agent that could modulate neuroactive mediators in the skin.

“This is a kind of brand-new area of investigation, and in the future, [there] could be topical products or cosmetics designed to address…internal mental well-being, not only because the skin improves, but also to affect directly our emotions,” Berardesca said.

He said the next step is to explore AI-driven skin mapping and biosensor technology to identify neurochemical patterns in skin physiology. The goal: develop personalized topical treatments that can modulate both cutaneous inflammation and mood.

Jafferany noted that extensive research has focused on the skin-brain axis, especially regarding the immune-neural connection. He highlighted that many medications are under investigation, including biologics and JAK inhibitors, which target interleukins, a key feature of various inflammatory skin conditions. This approach represents a shift toward modulating these chemical mediators to treat dermatological inflammation.

“In the past, we simply just used local applications and corticosteroids and traditional medications, but since the increase in knowledge about this basic molecular level, about the JAK inhibitors and biologics, things have changed,” Jafferany said. “Now, [many] inflammatory conditions, like atopic [dermatitis], eczema, [and] psoriasis, are being treated.”

 professor at Central Michigan University & president of the Association for Psychocutaneous Medicine of North America

a dual-board-certified dermatologist and pediatric dermatologist at Ada West Dermatology.

Relevant disclosures include Otsuka America Pharmaceutical for Jafferany and Arcutis Biotherapeutics and LEO Pharma for Swanason. Berardesca has no relevant reported disclosures.

Scutari M, Kerob D, Salah S. Inferring skin-brain-skin connections from infodemiology data using dynamic Bayesian networks. 

. 2024;14(1):10266. Published 2024 May 4. 

Jackson-Cowan L, Cole EF, Arbiser JL, Silverberg JI, Lawley LP. TH2 sensitization in the skin-gut-brain axis: How early-life Th2-mediated inflammation may negatively perpetuate developmental and psychologic abnormalities. 

Yildirim AM, Pradhan T, Zinn ZA. Dupilumab treatment for atopic dermatitis is associated with decreased utilization of psychostimulants for attention deficit hyperactivity disorder: A retrospective cohort study. 

Aitella E, De Martinis M, Romano C, Azzellino G, Ginaldi L. Neurogenic Inflammation in Allergic Contact Dermatitis. 

Andrus E. Jessica Hui, MD: Non-Visible Considerations for Eczema Management. Dermatologytimes.com. Published October 14, 2024. Accessed October 31, 2025. 

https://www.dermatologytimes.com/view/jessica-hui-md-non-visible-considerations-for-eczema-management

Videos

Research reveals a significant skin-brain connection, linking inflammatory skin diseases to neurocognitive and emotional health, particularly in children with atopic dermatitis.

2025 Fall Clinical Dermatology Conference

 in Las Vegas, following the session, ‘Where Oral Therapies Fit in an Injectable Landscape for Psoriasis Management,’ 

Swanson is known for her role as a dual-board-certified dermatologist and pediatric dermatologist at Ada West Dermatology. In light of Swanson’s session, during which she highlighted injectable and oral options for patients with 

 editorial team asked her about the topics covered in this talk.

Oral Therapies and Injectables in the Psoriasis Pipeline, With Lisa Swanson, MD

“At Fall Clinical 25 I got the chance to participate in a wonderful session with Dr. Tiffany Mayo and Dr Linda Stein Gold, where we talked about IL-23 inhibition for the treatment of plaque psoriasis,” Swanson explained. “And you might say, ‘That's old news, Lisa, because we have three IL-23 inhibitors that are injectables, and we've had them for years.’ But we talked about an oral peptide that works to inhibit IL-23, and yes, you heard me right. This is an oral peptide that inhibits IL-23. They said we could never experience biologic mechanism of action in a pill, because the molecules were simply too big.”

The US Food and Drug Administration (FDA) received a 

New Drug Application (NDA) for icotrokinra

, specifically aiming for an indication for adults and pediatric patients 12 years of age and older with moderate-to-severe psoriasis.

 As Swanson highlighted, this medication is designed to selectively block the interleukin (IL)-23 receptor, a key inflammation driver in psoriasis.

“The science is wonderful and amazing, and now we will hopefully soon have this FDA-approved oral option called icotrakinra,” Swanson said. “We talked about how it was studied in patients as young as 12 years old. I love that. As a pediatric dermatologist, the efficacy endpoints are remarkable. The first time I saw them, I was truly surprised at how efficacious it was. We know what to expect from our injectables. I think the pill medications that we've had have always skewed a little bit lower on the efficacy totem pole. This pill packs a punch.”

Swanson noted that she hopes icotrokinra, following an approval, can help younger and older patients with psoriasis who are needle-phobic or simply dislike injectables. If approved, icotrokinra could place clinicians in a position where an oral therapy could deliver the same potential efficacy as a shot, but in a once-a-day pill form.

“I was also recently introduced to the idea that I had a teenager who was then heading off to college, and that teenager was on an injectable,” Swanson said. “But once they got to college, they found it too difficult to manage the refrigeration, because in the dorm, it's a small fridge. There's other stuff they need to put in there, and so it was for that reason that that patient chose to switch to a pill.”

For any additional information on the topics covered in Swanson’s interview, view her full interview segment posted above.

In this summary, the quotes included were edited for clarity.

Swanson previously disclosed serving as a consultant for AbbVie, Alphyn, Arcutis, Boehringer Ingelheim, Castle, Dermavant, Galderma, Incyte, Janssen, Leo, Lilly, Novan, Pfizer, Sanofi-Regeneron, and Verrica.

Mayo T, Stein Gold L, Swanson E. CME Satellite Symposium: Where Oral Therapies Fit in an Injectable Landscape for Psoriasis Management. Session presentation at the 2025 Fall Clinical Dermatology Conference, Las Vegas, Nevada, Oct 23-26, 2025.

Smith T. Johnson & Johnson Submits NDA for Icotrokinra in Adolescents, Adults with Psoriasis. HCPLive. July 21, 2025. Accessed October 30, 2025. 

https://www.hcplive.com/view/fda-receives-new-drug-application-icotrokinra-adolescents-adults-psoriasis

In this interview, Swanson highlights the topics covered in her session on oral and injectable medications, and specifically icotrokinra, in the psoriasis pipeline.

Dermatology Education Foundation (DERM) 2025 NP/PA CME Conference

 in Las Vegas, Lisa A. Swanson, MD—a dual-board-certified dermatologist and pediatric dermatologist at Ada West Dermatology—discussed the challenges of dealing with parents of pediatric patients, emphasizing the need for adaptability and understanding parental priorities.

Swanson touched on this topic as part of a discussion of her presentation at the conference on speaking with parents. During her interview with 

, Swanson advocated for a technique called "gentle persistent persuasion," gradually introducing and discussing treatments like isotretinoin or dupilumab to parents who are initially hesitant.

Tips for Dealing with Parents as a Clinician in Dermatology, with Lisa Swanson, MD

“If I have a patient who has scarring acne, but the parents aren't ready to consider isotretinoin, I will, at each visit, talk about it, discuss it, answer questions about it, gently encourage, bring up points that I think are valid,” Swanson explained. “I hope that over time, eventually, they become more amenable to the therapy. The same could be said for the kiddo with severe atopic dermatitis, where I think dupilumab would be a nice fit, but the family's not ready for it yet. Understandable. We take it one day at a time, one visit at a time.”

The importance of empathy was highlighted by Swanson, especially when parents express opinions different from the physician’s advice, to avoid defensiveness and maintain a collaborative relationship. In cases of disagreement between parents and teenagers, finding a compromise is suggested to address both parties' concerns effectively.

“Sometimes, particularly in the teenage age group, you will encounter a situation where you've presented a list of options to a patient and their family, and the teenager vocalizes that they want to go one way, and the parent vocalizes very strongly that they would want to go another way,” Swanson said. “In these situations, I try to find a point of compromise. I try to agree with both sides. I'll say to the teen, ‘Of course, you are troubled by your acne. I understand that it poses a daily problem for you as you try to go to school, and you're feeling less confident and self-conscious about your acne. I completely understand that, and I think that can be a good reason to perhaps pursue a more aggressive choice like isotretinoin...I might say, ‘I also see your side’ [to the parents].

In many circumstances, Swanson pointed out, parents and their children have not tried a prescription medication yet and may be afraid that switching straight to isotretinoin is too abrupt. She emphasized that a good compromise would be to go with the parents' choice at first, but to decide later if the teen should be given their own choice in the matter after results are observed.

For more about the topics covered in Swanson’s session at the conference, view her full interview video above. To find out more from DERM 2025, view our 

The quotes contained in this interview summary were edited for clarity.

Swanson has served as a speaker and/or consultant for Abbvie, Almirall, Alphyn, Arcutis, Boehringer Ingelheim, Castle, Dermavant, Galderma, Incyte, Johnson & Johnson, Leo, Lilly, Novan, Pfizer, Sanofi-Regeneron, and Verrica.

Swanson speaks in this interview segment about her DERM 2025 session on speaking with parents and their children or teens as a clinician.

 in Las Vegas, Lisa A. Swanson, MD, spoke on-site at the meeting with the 

 team about her presentation titled ‘Systemic Therapy for the Pediatric Acne Patient.’

Swanson—a dual-board-certified dermatologist and pediatric dermatologist at Ada West Dermatology—discussed some of the main points highlighted in her session, including clinical pearls on the use of systemic therapy for 

 in young patients. She emphasized the importance of dermatologists being well-prepared to treat acne, which can consume a significant portion of a clinician’s time.

Advice on Systemic Therapy Use in Pediatric Acne, with Lisa Swanson, MD

“There's baby acne, which is harmless, and kids grow out of it, and it's no big deal,” Swanson said. “But then there's toddler acne, which is very important to treat because it can cause scarring. Toddler acne starts between the ages of 18 months and 3 years of age. Then there's what we call mid-childhood acne, which starts between the ages of 3 and 7. It's important to do a little bit of an endocrine workup for those kids because acne that starts during those ages is considered abnormal. You want to do a bit of a deeper dive to determine if there's anything else going on. You either want to send them to a [pediatric endocrinologist], or you want to do a little bit of blood work.”

Notably, Swanson highlighted that teenage acne is now appearing in children at younger ages. It used to be abnormal to have acne before the age of 9 years, she explained, but it is now only abnormal before the age of 7.

“One of the most common theories for why we're seeing acne younger is that it stems from hormones that are given to animals on farms, and then we might consume their animal products, so their meat or their eggs, or their milk,” Swanson explained.

Swanson was later asked if there were any clinical pearls for clinicians viewing her session or this interview that could help them in managing acne among patients with acne. Tips for addressing acne included:

Providing oral contraceptive pills both to treat acne and when one is starting a patient on a medicine for which they should not be getting pregnant

Demystifying isotretinoin by discussing its benefits and addressing the stigma associated with it

“I think all of us should feel comfortable prescribing oral contraceptive pills,” Swanson said. “During my talk, I shared the counseling that I give to patients and send their parents when I'm first starting those therapies, and hopefully, people left empowered to go ahead and prescribe those therapies themselves. The other thing I hope I trained the people to do is to have a good, solid discussion of the pros and cons of isotretinoin treatment. Isotretinoin has a little bit of baggage with it because of the iPLEDGE program, and it kind of has this big deal feel to patients and their families.”

To find out more about the topics covered in Swanson’s talk at the conference, view her full interview posted above. For more from DERM 2025, view our 

Swanson L. Systemic Therapy for the Pediatric Acne Patient. Presented at DERM 2025 NP PA CME Conference; July 23-26, 2025; Las Vegas, Nevada.

In this interview, Swanson highlights her DERM 2025 session ‘Systemic Therapy for the Pediatric Acne Patient’ and its takeaways.

Lisa A. Swanson, MD

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