- Several studies show a correlation between stress and acne breakouts
- While stress is not the direct cause of acne, it can make skin more prone to this condition or worsen existing symptoms
- Stress acne can be effectively treated or controlled with over-the counter medications, appropriate skin care products and calming strategies
Acne develops when excess sebum (oil), dead skin cells and debris accumulate in follicles to form comedones and pimples. When bacteria becomes trapped and multiplies, inflammation develops and symptoms worsen. These stages are integral to the formation of both noninflammatory and inflammatory acne, including stress acne.
Does Stress Really Cause Acne?
While most studies have examined the link between emotional distress and mental health as a result of acne, until recently, few have studied whether it can actually cause or exacerbate this skin condition.
In recent years, studies have shown that stress can affect both acne onset and severity.
How does stress cause acne?
In what is known as the brain-skin connection, the brain discharges corticotropin-releasing hormone (CRH) which triggers a process that releases cortisol.
Cortisol is a hormone that has many functions in the body such as regulating metabolism and immune function, and facilitating the inflammatory response. Stress can overactivate this immune system and produce an elevated inflammatory response that causes acne to form.
Stress also impacts the balance of bacteria in your gut, which also contributes to inflammation and triggers acne flare-ps.
During times of distress, the body releases adrenaline and cortisol to gain a boost of energy in a fight or flight response. While it can be beneficial in the short term, studies have shown that long-term or severe stress responses can cause cortisol dysfunction and widespread inflammation; intense or prolonged emotions of stress, anger, fear can strongly impact skin health.
CRH activity also has a stimulating effect on the sebaceous glands, causing increased sebum production which also contributes to lesion formation.
In one study examining the relationship between psychiatric illnesses and acne prevalence, researchers found stressful life events and mental illness correlated with a higher incidence of acne. Emotional stress was also identified as having a significant influence in one small study of students during nonexamination and examination periods.
The level of tension also has an impact on acne severity. One study of female medical students demonstrated a strong relationship between these two variables. In another study of adolescents, researchers found a significant association between stress and severity of acne.
When looking at demographics, women are more susceptible to stress-related bouts of acne. Women have a higher rate of anxiety, reduced self-esteem, stress-related depressive disorders and gender-specific triggers such as menstruation, pregnancy and menopause.
Lastly, emotional distress can cause some people to pick at their blemishes, causing the spread of bacteria and increasing the likelihood of scarring – which all contribute to greater levels of stress and creates a never-ending circle.
Identifying Stress Acne
Stress acne presents in the same way as any other type of acne. You may notice just a few blackheads and whiteheads, which are mild noninflammatory symptoms; or red, tender pus-filled cysts and pustules, representative of inflammatory acne.
Where on the body will it appear?
Stress acne, like any form of acne, can develop anywhere on the body except the palms and soles of the feet. However, it is more likely to form where there are the most sebaceous glands such as the face, shoulders, back and chest. This is where sebum is more likely to accumulate and clog pores.
How to Get Rid of Stress Acne
You can get rid of acne by following a multimodal approach: identifying and reducing stressors, treating existing acne lesions and preventing future breakouts with active acne-fighting agents.
Know your triggers
Anxiety and tension can be felt in a number of ways and brought on by a great range of triggers; it can be short term or long-term depending on the circumstances. It can be due to trauma, overwhelming responsibilities, anxiety, a troubled relationship or a major life change. Stress also has a negative impact on sleep and eating patterns which also affects skin health.
You may not be able to eliminate all the pressures in your life but there are several ways you can reduce them which will help calm your mind and skin.
Seek the support of a professional
Working with a therapist can be an effective strategy for reducing psychological or emotional anxiety through talk therapy; you can also learn valuable coping skills to help you alleviate your stress.
One form of therapy that is known to be effective in treating stress is cognitive behavioral therapy (CBT) which helps patients control negative thoughts and understand their moods and emotions.
Negative thinking can disrupt the balance of hormones in the body and reduce the levels of chemicals in the brain that are responsible for happiness.
Another form of therapy called Pythagorean self-awareness intervention (PSAI) is another stress management technique. This technique was effective in reducing anxiety in one small study of women with acne, with significant improvements in acne symptoms.
Make time during your day to include one or more activities that you enjoy, or try something new:
- Listen to calming music; this has been shown to reduce cortisol levels and induce relaxation
- Practice yoga; this has a positive effect on your mental and physical well-being
- Meditate to calm negative thoughts and clear your mind
- Deep breathing, also known as yoga breathing can have a profound effect on stress levels; a single exercise has been shown to reduce blood pressure and increase heart rate variability. (People with a high heart rate variability tend to be less distressed)
- Exercise can reduce levels of adrenaline and cortisol stress hormones
You can choose from a number of proven over-the-counter (OTC) topical treatments to treat your acne symptoms.
Benzoyl peroxide can help dry up comedonal acne but is most effective against inflammatory acne due to its ability to kill bacteria. It can be found in cleansers, toners, gels, moisturizers and creams, and can be used for large areas or as a spot treatment.
Salicylic acid is a chemical exfoliant that penetrates deep within pores to treat comedonal acne by clearing pores of excess oils, dead skin cells and debris. Many skin care products contain this agent, including cleansers, toners, gels, moisturizers and peels.
Acne treatments are known to dry and irritate skin and cause skin barrier dysfunction. To counteract these effects, include an oil-free moisturizer that contains glycerin and ceramides. Both play a key role in moisturizing and strengthening the skin barrier.
Moisturizers containing ceramides can complement acne therapy by improving skin, and reducing inflammation and irritation.
A consistent and effective skin care routine will also work as a preventative by keeping pores clear through cleansing and exfoliating; regular moisturizing plays a key role in maintaining a healthy skin barrier and reducing the risk of acne breakouts
Stress, especially prolonged episodes, has been demonstrated to negatively impact skin.
During times of distress, the body releases hormones including adrenaline and cortisol which results in a heightened inflammatory response. These hormones also stimulate oil-producing glands which causes excess oils to accumulate with dead skin cells and debris. This results in blocked pores and triggers comedonal acne or inflammatory acne when bacteria becomes trapped and multiplies.
There are a number of solutions available to help you reduce your stress levels; you can include one or more relaxation techniques into your daily schedule and you can schedule regular appointments with a therapist.
To treat existing acne symptoms and prevent future flare-ups, benzoyl peroxide or salicylic acid are two proven solutions that can clear pores and reduce oiliness. Follow with a moisturizer containing ceramides and glycerin to moisturize, protect and maintain healthy skin.
- Jović A, Marinović B, Kostović K, Čeović R, Basta-Juzbašić A, Bukvić Mokos Z. The Impact of Pyschological Stress on Acne. Acta Dermatovenerol Croat. 2017;25(2):1133-1141. https://pubmed.ncbi.nlm.nih.gov/28871928/
- Chen Y, Lyga J. Brain-skin connection: stress, inflammation and skin aging. Inflamm Allergy Drug Targets. 2014;13(3):177-190. doi:10.2174/1871528113666140522104422
- Hannibal KE, Bishop MD. Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation. Phys Ther. 2014;94(12):1816-1825. doi:10.2522/ptj.20130597
- Zouboulis CC, Seltmann H, Hiroi N, et al. Corticotropin-releasing hormone: an autocrine hormone that promotes lipogenesis in human sebocytes. Proc Natl Acad Sci U S A. 2002;99(10):7148-7153. doi:10.1073/pnas.102180999
- Zari S, Alrahmani D. The association between stress and acne among female medical students in Jeddah, Saudi Arabia. Clin Cosmet Investig Dermatol. 2017;10:503-506. Published 2017 Dec 5. doi:10.2147/CCID.S148499
- Yosipovitch G, Tang M, Dawn AG, et al. Study of psychological stress, sebum production and acne vulgaris in adolescents. Acta Derm Venereol. 2007;87(2):135-139. doi:10.2340/00015555-0231
- Bondade S, Hosthota A, Basavaraju V. Stressful life events and psychiatric comorbidity in acne-a case control study. Asia Pac Psychiatry. 2019;11(1):e12340. doi:10.1111/appy.12340
- Chiu A, Chon SY, Kimball AB. The response of skin disease to stress: changes in the severity of acne vulgaris as affected by examination stress. Arch Dermatol. 2003;139(7):897-900. doi:10.1001/archderm.139.7.897
- Dreno B, Bagatin E, Blume-Peytavi U, Rocha M, Gollnick H. Female type of adult acne: Physiological and psychological considerations and management. J Dtsch Dermatol Ges. 2018;16(10):1185-1194. doi:10.1111/ddg.13664
- Bhate K, Williams HC. Epidemiology of acne vulgaris. Br J Dermatol. 2013;168(3):474-485. doi:10.1111/bjd.12149
- Carlson LE, Toivonen K, Subnis U. Integrative Approaches to Stress Management. Cancer J. 2019;25(5):329-336. doi:10.1097/PPO.0000000000000395
- Moorey S. The six cycles maintenance model: Growing a “vicious flower” for depression. Behav Cogn Psychother. 2010;38(2):173-184. doi:10.1017/S1352465809990580
- Ma X, Yue ZQ, Gong ZQ, et al. The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Front Psychol. 2017;8:874. Published 2017 Jun 6. doi:10.3389/fpsyg.2017.00874
- Chatzikonstantinou F, Miskedaki A, Antoniou C, Chatzikonstantinou M, Chrousos G, Darviri C. A novel cognitive stress management technique for acne vulgaris: a short report of a pilot experimental study. Int J Dermatol. 2019;58(2):218-220. doi:10.1111/ijd.14227
- Linnemann A, Ditzen B, Strahler J, Doerr JM, Nater UM. Music listening as a means of stress reduction in daily life. Psychoneuroendocrinology. 2015;60:82-90. doi:10.1016/j.psyneuen.2015.06.008
- Lynde CW, Andriessen A, Barankin B, et al. Moisturizers and Ceramide-containing Moisturizers May Offer Concomitant Therapy with Benefits. J Clin Aesthet Dermatol. 2014;7(3):18-26. https://pubmed.ncbi.nlm.nih.gov/24688622/