- Scientific research confirms the long-held belief that stress can aggravate acne breakouts.
- Stress management techniques can reduce the likelihood and severity of these flare-ups.
- Prescription medications and in-office techniques can also be beneficial in more severe cases.
You’re probably familiar with the idea that psychological health is intimately linked to physical wellness. Stress seems to impact just about every aspect of the body, from the digestive tract to the immune system.
Your skin is no exception. Maybe you’ve noticed that acne outbreaks seem to appear just as you are coping with a stressful situation, whether it’s finals at school or an important presentation at work.
Over the past two decades, scientific research has been accumulating to support the theory that, although stress generally does not cause outbreaks in patients with no history of acne, those who already struggle with acne can have outbreaks induced or exacerbated by stress.
Stress can affect the physiological processes that directly influence acne, such as oil production in the skin. It can also influence other behaviors that contribute to outbreaks, such as poor dietary and lifestyle choices.
Thankfully, there are several effective strategies for the prevention and treatment of stress-induced acne.
What Scientific Research Says About Acne and Stress
In 2003, scientists published one of the first studies to provide evidence that stress could indeed lead to the exacerbation of acne. Researchers examined a group of college students to determine if there was a relationship between stress levels related to academic examinations and acne flare-ups.
The results of the study confirmed that students experienced worsening acne breakouts during periods of high stress. Several other studies have been conducted since, allowing scientists to draw the following conclusions.
1. Stress activates oil glands
Scientists believe that there are receptors for stress hormones in the skin cells responsible for producing sebum, an oil the skin produces that mixes with dead skin cells and causes acne.
During stressful times, the body produces more stress hormones, such as cortisol, which in turn leads to an increase in the production of sebum, leading to outbreaks in patients prone to acne. Cortisol may also lead to inflammation in the skin (more on this below).
2. Stress causes acne, which in turn may cause more stress
As patients suffer from acne outbreaks—whether due to stress or not—the outbreaks themselves may make them feel stressed out, anxious, or depressed. That stress could in turn lead to worsening outbreaks of acne, and so the cycle continues.
This sort of stress may also lead patients to pick at existing blemishes, leading to slower healing times and the formation of scars, which both feed back into the cycle of stress and acne.
3. Stress influences inflammatory mediators in the skin
A recent review of the available scientific literature explores the various hormones, neuropeptides, and inflammatory cytokines that the body produces in response to emotional stress. The authors suggest that psychologists and psychiatrists could participate in the interdisciplinary care of patients with acne to best manage the condition.
Dr. Tsippora Shainhouse, a board-certified dermatologist in Beverly Hills and a clinical instructor at the University of Southern California, agrees with this assessment. According to Shainhouse, “stress can spike cortisol levels that, in turn, trigger an inflammatory cascade that can exacerbate acne in acne-prone people.”
4. Stress leads to poor dietary and lifestyle choices
According to Dr. Rhonda Q. Klein, a dermatologist from Modern Dermatology in Westport, CT, stress can affect how patients eat, which in turn influences acne. She explains, “We do think high carb, high sugar, and high dairy diets can worsen acne, and when people are stressed, they often do not eat as healthy as normal, so this is one confounder as well.”
In response to stress, patients may also deviate from their normal routines and turn to bad habits. In particular, they may not keep up with regular bathing and skin care routines. Sleep quality and sleep quantity too could suffer. These behaviors may lead to further physical stress, feeding back into the cycle of stress and acne.
“In a holistic sense, excess stress often causes people to eat unhealthily (more greasy, fattening & sugary foods), which can lead to breakouts,” confirms physician and health consultant Dr. Erin Stair. “It also affects people’s sleep patterns, and poor sleep won’t allow the skin to heal itself optimally.”
How to Manage Your Stress and Prevent Acne Flare-Ups
There are many stress management techniques that can help patients with acne minimize the impact of stress on their skin.
- Psychotherapy, commonly referred to as talk therapy, can help a person manage stress and anxiety by meeting with a counselor or psychologist. Cognitive Behavioral Therapy (CBT) is a specific type of psychotherapy that helps patients identify and change thought and behavior patterns that are ineffective or harmful.
- Meditation is a state of thoughtful awareness in which you attempt to quiet the mind, hopefully providing relief from worry or anxiety. There are many types of meditation that you can do at home, some using free online recordings or apps that you can download onto your smartphone, such as Headspace.
- Hypnosis is a state of consciousness, usually facilitated by a clinician such as a psychologist, in which the patient becomes relaxed and suggestible, and possibly open to messages about changing or breaking bad habits.
- Yoga and tai chi are two physical practices that use movement, breathing, and mental concentration to promote relaxation and improved health. “Yoga is great,” says Dr. Stair. “If you only have time for breathing exercises, inhaling through your nose for 3 seconds, and exhaling for a longer duration through your mouth can be super relaxing.”
- Medications, such as antidepressants (Zoloft®, Wellbutrin®) and beta blockers (propranolol, metoprolol), can also help to manage anxiety and stress.
In-Office Treatment Options
Regarding stress acne, Dr. Rhonda Q. Klein recommends, “For ‘stress pimples,’ I think in-office treatments, such as photodynamic therapy, facials, peels, and light laser treatments, can be helpful as they force the patient to relax for a short period of time.”
Often, once a patient is in the middle of an acne breakout, it’s time to turn to one of the many tried and true medications for acne treatment, such as:
- Topical benzoyl peroxide or salicylic acid, which can be used as spot treatments for pimples
- Retinoids, either topical (tretinoin) or oral (isotretinoin)
- Antibiotics, either topical (clindamycin) or oral (minocycline or azithromycin)
- Hormonal medications, such as birth control (oral contraceptives) or spironolactone
- Herbal products, such as topical tea tree oil, which is also a good spot treatment
Dr. Stair offers these final words of advice: “When a breakout happens, I would first recommend keeping a journal so you can determine your triggers,” she says. “Document what you ate, things that stressed you out, sleep patterns, and any creams or lotions you used… You may be able to modify certain lifestyle factors to reduce breakouts, but sometimes you’ll need to visit a licensed skin specialist if your condition is more severe and out of your control.”
» For more information, refer to Zwivel’s Complete Guide to Acne Causes and Treatments.
- American Academy of Dermatology: Managing Stress Can Help People Improve Their Skin Conditions (2011) aad.org/media/news-releases/managing-stress-can-help-people-improve-their-skin-conditions
- American Psychiatric Association: What is Psychotherapy? (2016) psychiatry.org/patients-families/psychotherapy
- The Impact of Psychological Stress on Acne (2017) hrcak.srce.hr/185020?lang=en
- The Response of Skin Disease to Stress Changes in the Severity of Acne Vulgaris as Affected by Examination Stress (2003) jamanetwork.com/journals/jamadermatology/fullarticle/479409
- The University of California, Los Angeles (UCLA): Guided Meditations (2017) uclahealth.org/marc/body.cfm?id=22&iirf_redirect=1