Does stress cause acne?

Although stress does not directly cause acne, it is one of the factors that makes acne worse. Different people handle stress differently: Some lose their hair; others get ulcers, whereas still others get migraines or have other physical or psychologic side effects. Basically, stress can make any condition worse. There are excellent ways to manage stressful situations, which can have profound effects in the treatment of acne.

When people are under stress they do things differently: They eat different foods, usually foods that are higher in fat and sugar. They sleep less, and the quality of the sleep that they do get is generally poor. They also react to situations differently, getting angry more easily and maybe picking at their skin more, or being less compliant with their acne treatment regimens.

Hormones called cortisols are released in times of stress. These hormones were very helpful in primitive times in helping us survive life-threatening situations. They are known as the “fight or flight” reactions. The release of these hormones puts the body on high alert. Our palms sweat, the heart rate increases, and all of our energy becomes available in one blast to get us through the immediate, threatening stressor.

This was fine, even necessary, in the days when so much that happened was a matter of life or death. Now, when it comes to stressors that we currently experience, chances are that we do not need such high levels of cortisols to see us through. But that is what we get. In response to the stressor, whether it is an exam or meeting or date or any other perceived good or bad factor, we release the same hormones, cortisols. The longer term effects of increased cortisols are suppression of the immune system and, of course, acne, as the Propionibacterium acnes bacteria flourishes in the depressed immune state.

Ah, ask any student if they break out just before an exam and they'll tell you, "Yes!"

Stress can lead to a release of "stress" hormones such as cortisol. Although this is not a primary cause of acne, it certainly can trigger a break-out. So does picking at spots on your face (which we all do when studying for a test).

Stress can contribute to acne due to its effect on hormones, inflammation, blood sugar, and elimination.

Sugar and imbalanced hormone ratios have been linked to breakouts in various studies. Stress produces more of the hormone cortisol. High cortisol triggers more insulin in order to allow for quicker fuel breakdown, via sugar, during the stress response. Not only does this create a diet that is unhealthy, due to an increases sugar cravings, it leads to more inflammation. This affects skin and the body’s immune system to ward off bacteria.

Another way stress effects skin is via its elimination function. Our skin is the largest organ of our body. It is the 5th organ of elimination, along with the kidneys, bowels, lungs, and liver. When one is stressed, digestion slows down. Furthermore, the liver  gets overloaded with an increase in processing stress chemicals and lung excretion becomes less optimal due to shallow breathing. When the digestive tract and lungs are backed up, the skin and kidneys must do all the work. This can create various imbalances in the body. Meaning—a backed up colon could result in a pimply face.

Consider the behaviors that are different when you are stressed. Do you spend more time touching your face, do you change hygiene habits, does your diet change, do you change your exercise habits? Perhaps stress has little evidence for directly causing acne, but it may precipitate other factors that may.

There's not a man or a woman alive who at some point hasn't looked in the mirror, said, "Uh-oh," and wished for a magic pimple-erasing potion. Especially because pimples often erupt just before a Big Day.

Blame stress. It's why grown-ups continue to break out long after the sex hormones that wreak havoc in teenage skin have calmed down. Weddings, speeches, presentations, and other tense events send stress hormones soaring. In fact, skin researchers found that a mock job interview slows down skin healing as much as sleep deprivation does. But any stressful situation—happy or sad—can do it.

When stress hits, a SWAT team of hormones primes your body for fast action. Among the racing hormones is one called corticotropin-releasing hormone (CRH). In your skin, CRH causes the kind of inflammation that triggers acne. If you absentmindedly touch a blossoming pimple again and again or (worse) squeeze it, you increase the inflammation, making things worse.

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