Abstract
Skin aging is a multifactorial process driven by intrinsic chronological mechanisms and extrinsic environmental and lifestyle factors, among which psychological stress has gained recognition as a key accelerator. This narrative review synthesizes current evidence from dermatology, psychoneuroimmunology, and environmental health on how ultraviolet radiation, air pollution, tobacco smoke, and psychological stress independently and synergistically drive accelerated skin aging at the molecular level. Environmental stressors primarily inflict oxidative stress, DNA damage, and chronic inflammation (inflammaging) via AhR, NF-κB, and AP-1 pathways, leading to collagen degradation, elastosis, and pigmentary changes. Psychological stress activates the HPA and SAM axes, elevating cortisol and catecholamines that impair epidermal barrier function, suppress DNA repair, accelerate telomere shortening, and promote neurogenic inflammation. Importantly, these stress mediators synergize with pollutants at shared redox-sensitive nodes, with catecholamines crippling UV-induced DNA repair and cortisol amplifying AhR-driven MMP expression. Mitochondrial dysfunction emerges as a central hub of mutual amplification. Clinical stigmata range from coarse wrinkling and solar lentigines to the "smoker's face" and stress-exacerbated barrier disruption. We highlight integrated interventions: topical broad-spectrum sunscreens with antioxidants, emerging anti-pollution agents, and mind-body practices like mindfulness-based stress reduction. A holistic exposome approach is crucial; understanding mechanistic overlaps enables novel prevention strategies that combine dermatological care with psychological resilience, addressing root causes rather than merely consequences