Can stress cause pimples and how are stress and acne related?

Acne and stress
Stress may cause or trigger pimples and acne

Our skin is our largest organ and a mirror of our physical and mental wellbeing. 

As anyone who has experienced it knows, living with acne-prone skin and acne can be very stressful. You can read more about that in the psychological impact of acne.

In this article we look at the impact that psychological stress in either our personal or professional lives can have on our bodies in general and our skin in particular. We explore the relationship between stress and acne, how stress might either cause or exacerbate blemishes and some of the things we can try to help reduce stress and minimise its impact on our skin.

What is stress and how does it develop?

Stress is a very individual matter: for some it is a stimulant, while for others it is a pressure.1 And, when it is a pressure, people react differently: some panic in the face of seemingly minor problems while others remain calm when dealing with greater difficulties.

 

There is a difference between `good stress` (eustress) and `negative stress` (distress). In stressful situations the body produces hormones such as adrenalin and cortisol, blood pressure rises and the body goes into alert mode. For our ancestors it was advantageous for survival to be in this state in dangerous situations and to be able to fight or flee.

Between 50-80% of acne patients agree to statements that stress makes it worse (1)

Stress these days has diverse causes. These can include: psychological burdens, frustration at work, distress in one's private life, problems with relatives or friends and illness. Pressure continues to grow as people feel they are expected to look great, be healthy, do sport, maintain friendships, be well-informed, etc. − and all the same time. It’s clear that many of us find it increasingly difficult to come to terms with these continually growing demands. And the consequences are apparent: the number of psychological disorders culminating in burnout has been rising for years.2

How could stress cause or trigger acne?

Stress can disrupt the metabolism: you may have trouble sleeping, your digestion suffers, you can feel depressed and perhaps irritable and out of balance. And, for many people, 

its not long before the effects show on the skin: it becomes itchy with a tendency towards redness and blemishes appear.

Emotional stress has long been associated with acne but research suggests that, until recently, science has underestimated the impact it has on acne severity.1

Exam stress caused student’s acne symptoms to worsen considerably

When we’re stressed, our bodies produce hormones (such as cortisol and adrenal androgens), neuropeptides (nerve proteins such as endorphins and insulin) and inflammatory cytokines (small proteins that trigger inflammation) which influence the behavior of the sebaceous glands and can aggravate acne.
You can find out more about the sebaceous glands in the development of acne and the causes and triggers of acne. You can also read more in acne and hormones.

Numerous research reports, many of which are questionnaire-based, suggest that acne patients associate their condition with stress with between 50% and 80% of them agreeing to statements that stress makes acne worse.1 One study shows that patients with acne reported a lag time of two days between a stressful episode and the exacerbation of acne. 1
 Stress can also cause some people to pick at their blemishes which can spread bacteria and cause more inflammation so that mild acne symptoms get worse. This is known as Acne Excoriée and you can find out more about it in the different types of acne.

Once blemishes have been triggered, research has also show that stress slows down wound healing by up to 40 %so blemishes are likely to take longer to heal.


 

Research by the University Clinic of Dermatology at Stanford University School of Medicine reveals a pathogenic (i.e. disease-causing) correlation between chronic stress and the worsening of acne.(4)

When the stress levels of the participating students rose – around exam time and under acute performance pressure along with the associated lack of sleep and changes in eating habits – increased pain intensity and a significant prolonging of the wound-healing process was observed. On top of this, skin condition worsened. 

4 - http://jamanetwork.com/journals/jamadermatology/fullarticle/479409)

What does stress acne look like?

Stress acne is likely to take the form of an increased number of blackheads (closed comedones), whiteheads (open comedones) and pimples. You can find out more about the appearance of these different types of blemishes in the development of acne.
There are many different forms of acne and you can read more about them in the different types of acne.

Tips for reducing stress

If everything seems to be going crazy around you, and everyone wants something from you at the same time, it’s not easy to keep your cool. Here are some things that you can do to try to stay calm and become more resistant to everyday stress:

Relaxation techniques 
Autogenic training, yoga, meditation, wellness treatments and methods of traditional Chinese medicine (TCM) can help you to relax, develop a positive mental attitude and improve self-confidence.

Sport and exercise

Sport releases endorphins (feel-good hormones) into the body. These help you to feel better about yourself and aid relaxation. A better level of fitness also contributes to feelings of self-worth. Find out more in Acne and sport.

Calming techniques can help you keep stress pimples under control

A healthy diet
A healthy, balanced diet with plenty of fresh vegetables, fruit and nuts can help you to deal better with stress. Try to drink more water and fewer alcoholic and caffeinated beverages which can trigger insulin production and exacerbate stress. You’ll find more suggestions on what to eat and what to avoid in what changes can I make to my diet to help my acne-prone skin?

For more advice on things you can try to keep stress and blemishes under control read tips for reducing stress.

1 Impact of psychological stress on acne. Jović et al. Acta Dermatovenerol Croat 2017; 25(2): 133-141
2 http://www.gostress.com/stress-facts/
3 Marucha PT, Kiecolt- Glaser JK, Favagehi M. Mucosal wound healing is impaired by examination stress. Psychosom. Med. 1998;60:362-5.