Studies show elevated cortisol and catecholamines with chronic emotional stress, anxiety, and depression, contributing to increased production of pro-inflammatory cytokines (eg, IL-6, TNF-α, and CRP) which impair immune homeostasis, creating a systemic pro-inflammatory state that both exacerbates dermatological disease activity and neuroinflammation.139. The gene discussed is TNF; the disease is major depressive disorder.