Acne affects more than 90% of the population at some point in their life. Recent studies show that adult acne affects more than 50% of women in their 20s and 25% of women in their 30s.
Acne flares up for many different reasons, including diet, exercise regimens, poor skin routine, hormone imbalances… the list goes on and on. It typically impacts areas of the skin with many sebaceous follicles, including the face, chest, and back.
Despite the amount of research done on skincare, the relationship between acne and stress has been misunderstood for years. Contrary to popular belief, stress alone cannot directly cause acne. However, one thing is definite - stress hinders the skin's healing process and can contribute to breakouts by affecting various systems within the body.
How does stress contribute to acne?
When there's an underlying medical or psychological problem happening within the body, it will often manifest on the skin. Research conducted by the University Clinic of Dermatology at Stanford University School of Medicine reveals a direct correlation between chronic stress and acne's worsening. While it's been determined that stress single-handedly cannot cause acne, it's clear that stress can trigger unwanted activities in the body, which may lead to acne and other skin conditions, including eczema, rashes, and rosacea.
1. Stress can cause hormone imbalances
Like all acne types, stress acne is caused by an unwelcome mixture of oil, bacteria, inflammation, and possible hormone imbalances. When your brain gets the signal to enter into "stress mode," it increases cortisol production, your body's primary stress hormone. This causes an overproduction of oil in your skin glands and spikes in adrenaline. When your body faces spikes in certain hormones, especially those secreted from the adrenal glands, it strips moisture from the skin to prevent dehydration in other systems of the body. To reduce moisture loss, the skin then produces higher levels of sebum oil.
This increased oil production leads to clogged pores and, you guessed it - breakouts. It can also contribute to redness, irritation, and dullness in your complexion.
2. Stress affects the skin barrier function
Stress also interferes with proper skin barrier function. What is the skin barrier, you ask? Here's a quick anatomy lesson…
The outermost layer of skin (the skin barrier) is called the epidermis, which sits above the dermis. The dermis is home to sweat glands, blood vessels, nerves, and two essential structural proteins: collagen and elastin. These proteins are what give our skin bounce and firmness. Below the dermis is the subcutaneous layer made up of mostly fat cells to give our skin some cushion from our bones.
Since the epidermis is the layer that comes into contact with the outside world, its role is to defend the skin against environmental factors and foreign substances while simultaneously protecting your body's water balance. When this natural barrier is damaged, blemishes and acne flare-ups are common because bacteria and other harmful things can penetrate the skin more easily. Essentially, the epidermis functions to keep the good stuff in and the bad stuff out.
One study has shown that wounds, including acne, are significantly slower in healing when the skin barrier is damaged, inhabiting the skin's ability to repair itself - meaning slower healing times for breakouts.
3. Stress results in a lower cell turnover rate
Cell turnover is when your body builds new skin cells to replace old, damaged ones. When this process is delayed, cells aren't properly shed, causing blockages and debris buildup. When under stress, the body will send resources and nutrients to more essential organ systems resulting in a lower skin cell turnover rate.
4. Stress can make you touch your face
Stress can trigger the nervous system and cause you to feel an itching or burning sensation throughout the body. This irritation may cause you to touch, scratch absent-mindedly, and pick at your face and other problem areas. Picking at the skin is something you need to avoid when trying to heal blemishes! This habit can contribute to new breakouts and make existing pimples worse by introducing new bacteria to the area.
How do I know if this is stress acne?
Generally, acne caused by hormones, including stress acne, develops on the body's oiliest parts. This includes the chin, jawline, and cheek area and shows up on the face and neck sides. More times than not, they present themselves as deep cysts that evolve into angry, red pimples.
If you're dealing with more breakouts than usual, you may be experiencing one result of the domino effect caused by stress. Another telltale sign that you're facing a stress-related eruption is that you'll notice several new pimples at once, even if you aren't usually acne-prone.
Unfortunately, those who are predisposed to acne are likely to experience flare-ups when stressed - they may also be more susceptible to other unpleasant problems such as hyperpigmentation, wrinkles, premature aging, and dark spots.
If you believe your stress influences your skin's health, try taking note of when your stress levels are elevated and when you experience a breakout. Track this for a few weeks, then compare the times to see if there is a correlation.
What are the best treatment options for stress acne, according to dermatologists?
Treatment for moderate to severe acne can include topical or oral prescription medications from your doctor but can vary depending on the severity. If you experience a severe breakout, be sure to visit a dermatologist who will better assess what treatments will be most effective for you.
Mild acne can typically be treated with the right skincare routine and over-the-counter (OTC) medications. Some examples include:
Salicylic acid is one of acne's worst nightmares. It deeply penetrates the sebaceous glands and helps dissolve skin debris and unclog pores. It also acts as an anti-inflammatory and exfoliant - helping to break down dead skin cells and soften the outer layer of the skin. Salicylic acid is the active ingredient in some of the best-medicated acne cleansers and anti-acne treatment creams. It provides effective treatment without over-drying the skin.
Benzoyl peroxide is regarded by the American Academy of Dermatology as the most effective anti-acne topical treatment. It works to treat and prevent acne by killing acne bacteria on the skin's surface and deep in oil glands, unclogs skin pores, reduces excess sebum production in the skin's oil glands, and skin inflammation.
You may have heard of retinol from anti-aging skin care commercials. Retinol is one of the Vitamin A derivatives that are highly recommended by dermatologists. The same as other retinoids, retinol increases cell turnover rate, removing the top layer of dead skin cells, drying up excess oil, and killing any acne-causing bacteria. Retinol is especially effective in preventing and reducing comedones (blackheads and whiteheads) and improving skin texture.
Vitamin B5 (pantothenic acid) supplements
Pantothenic acid (Vitamin B5) is also called the "anti-stress vitamin"). It was shown that Vitamin B5 supplements could balance the secretion of stress hormones in the adrenal glands. Women with adult acne can benefit from DIM supplements. DIM supplements contain a natural extract of cruciferous vegetables (kale, broccoli, alfalfa, and spinach) specially formulated to help balance hormones and reduce signs of acne in women. Hormonal acne is typically located on the lower parts of the face (chin and jawline) and is influenced by the monthly cycle.
Practicing relaxation techniques
If you're facing a lot of stress, utilizing various relaxation techniques, such as deep breathing, may help regulate internal hormones and speed up your acne's healing.
Adequate hydration, zinc, and flaxseed oil-based product
To combat stress acne, you'll want to keep your skin hydrated inside and out. Water consumption can help with internal hydration, and zinc and flaxseed oil-based products have been proven to keep skin moisturized and help with wound healing. To keep the water in the skin, you will need to use a good moisturizer, preferably with niacinamide. Niacinamide moisturizers protect the natural skin barrier from overdrying and help with existing acne lesions' healing process.
How can I prevent stress acne?
Find your zen
Okay, this one may seem obvious, but one way to reduce acne is to decrease your stress levels. Take some time to decompress and relax - yoga, exercise, meditation, painting, deep breathing - whatever you can do to help keep your mind at ease. Incorporating regular self-care can be a game-changer when it comes to skin clarity and mental health.
Maintain your skincare routine.
Don't skip on your basic skincare needs! When you're feeling stressed or down, it's easy to forgo your typical routine. But you have to keep taking care of your skin. Remember to wash your face twice a day, use a gentle toner, exfoliate regularly, and use SPF daily. Incorporate a face mask into your skincare routine 1 - 2x per week as an excuse to unwind and relax for a few minutes. Tranquility and acne-fighting benefits all at once? Yes, please!
Catch enough Zzz's
Lack of sleep can create many reactions within the body, including increased inflammation and the production of stress hormones, both of which can destabilize your immune health and contribute to skin issues. Without regular restorative sleep, your body might not feel adequately rested and could jumpstart a cortisol surge, putting you at risk for breakouts.
Fix your gut health
It seems that stress can alter your intestinal microflora and contribute to systemic inflammation and insulin spikes. Increased inflammation and insulin levels lead to excess oil, which in turn leads to blemishes and pimples. When your digestive tract is healthy, everything else in the body can function as usual - keeping your skin clear and healthy. When your microbiomes are off, everything from your brain function to your energy levels and, of course, skin clarity can be impacted. Consuming more gut-healthy choices such as fermented foods, fiber-rich veggies, and adequate water can help keep your digestive tract happy and balanced.
Keep your hands off
We mentioned it earlier, but it is worth mentioning again - please do not touch, scratch, or pick your skin. This puts you at risk of contracting infection-causing bacteria that can make existing breakouts worse and increase your risk of developing new pimples. Excessive popping and touching can even lead to permanent scarring! If you're finding yourself subconsciously picking, consider putting a pimple patch on stubborn blemishes to help keep your hands off and speed up healing.
Q1. What is the connection between stress and acne?
A1. Stress can indirectly exacerbate acne by impacting various systems within the body. While it doesn't cause acne directly, stress can stimulate the production of hormones such as cortisol, leading to an overproduction of oil in your skin glands. This can result in clogged pores and breakouts. Furthermore, stress can interfere with the skin's barrier function, slow down the skin cell turnover rate, and make you touch your face more, all of which can worsen acne.
Q2. How does stress affect hormone balance and contribute to acne?
A2. When your brain perceives stress, it signals the body to enter "stress mode," causing increased production of cortisol, your body's primary stress hormone. This leads to an overproduction of oil in your skin glands and spikes in adrenaline. When the body faces spikes in certain hormones, it draws moisture from the skin to prevent dehydration in other systems. To counteract this, the skin then produces higher levels of sebum oil, which can lead to clogged pores and breakouts.
Q3. What is the skin barrier function, and how does stress affect it?
A3. The outermost layer of skin called the epidermis, functions as the skin barrier. Its role is to defend the skin against environmental factors and foreign substances while simultaneously protecting your body's water balance. Stress can interfere with this barrier function, damaging the epidermis and making it easier for bacteria and other harmful substances to penetrate the skin, leading to blemishes and acne flare-ups.
Q4. How does stress lower the cell turnover rate?
A4. Cell turnover is the process of your body creating new skin cells to replace old, damaged ones. When this process is slowed, cells aren't properly shed, leading to blockages and buildup of debris. Under stress, the body prioritizes resources and nutrients to more essential organ systems, resulting in a lower skin cell turnover rate.
Q5. How can I identify stress acne?
A5. Stress acne typically develops on the body's oiliest parts, such as the chin, jawline, and cheek area. It often presents as deep cysts that evolve into inflamed, red pimples. If you notice several new pimples at once, even if you're not usually acne-prone, you may be experiencing stress acne. Tracking your stress levels alongside your breakouts over a few weeks can help you identify a correlation.
Q6. What are the best treatment options for stress acne?
A6. Treatment for stress acne can range from topical or oral prescription medications for moderate to severe cases to over-the-counter medications for mild acne. Some examples include salicylic acid, benzoyl peroxide, and retinol. Practicing relaxation techniques, staying hydrated, and using zinc and flaxseed oil-based products can also help. Consult with a dermatologist for the best treatment options for your specific condition.
Q7. How does salicylic acid help treat acne?
A7. Salicylic acid deeply penetrates the sebaceous glands, helps dissolve skin debris, and unclogs pores. It also acts as an anti-inflammatory and exfoliant, helping to break down dead skin cells and soften the outer layer of skin, providing effective treatment without over-drying the skin.
Q8. How can Vitamin B5 supplements benefit individuals with acne?
A8. Pantothenic acid (Vitamin B5), also known as the "anti-stress vitamin," can balance the secretion of stress hormones in the adrenal glands. This balancing effect can reduce signs of acne, particularly in women.
Best supplements for people with stress-related acne
Retinol + Niacinamide treatment cream
Salicylic acid 2% acne treatment cream
Benzoyl peroxide 2.5%
More info on stress acne
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