Stress related manifestations on skin, hair and nails. The skin is the mirror of internal disease and the effects of stress have manifold expressions on the hair, nails and the skin itself. These may be purely cosmetic, or, occasionally, of a more serious nature. Often, one does not realize that one is 'stressed' enough to the extent of manifesting signs on the skin and it may take the dermatologist you seek to tell you the same. Certain specific skin diseases and conditions are purely psychic in origin, e.g., a delusion of parasitosis, trichotillomania and others and sometimes the skin is the first marker in identifying the presence of an underlying psychiatric disorder. Enumerated here are some of the more commonly encountered stress related conditions. 1. Sweating: generalized, or just of the palms and soles. 2. Hair: generalized hair fall, Alopecia Areata (patches of hair loss), Hirsutism (excessive dark, thick hair on the chin, beard and chest in women), Trichotillomania (breaking of scalp hair and eating it, seen especially in children), premature graying and/or balding. 3. Acne: especially late onset in the later 20's, 30s and 40's. Acne excoriee (scratched out acne with resultant scarring). 4. Pigmentation: dark patches in the face. 5. Pruritis (itching): - generalized / genital area 6. Urticaria: red raised itchy rash, sometimes with swelling of lips and eyes, also commonly known as 'hives'). 7. Eczemas 8. Precipitation of skin disorders: such as Lichen Planus, Psoriasis, Vitiligo, Leucoderma, Atopic Dermatitis. 9. Side effects of medication/drugs: skin rashes, acne, hair fall. 10. Anorexia (eating disorder): leading to dryness of skin, hair, premature ageing. 11. Early appearance of wrinkles, exaggeration of normal facial lines / expressions. 12. Eyes: puffiness, dark circles, eczemas. 13. Nails: Beau's lines - transverse ridges following severe physical illness, nail biting, dry brittle nails. It must be emphasized, however, that stress may not be the only cause of the above conditions. Other causes must be ruled out by way of history and clinical examination. Investigations should be done whenever required and will complete the work up. Treatment is tailored to the individual case. A happy, healthy mind is reflected on the skin. Fortunately, adverse effects can be reversed in most cases and preventable to a large extent; so let us smile more, cope better and glow with good health.