Does stress cause acne?

It's not your imagination -- feeling stressed does seem to cause some people to have acne flare-ups. The reason appears to be that stress causes your body to undergo changes in levels of certain hormones, which for some people may promote acne. One study in Singapore found that teens who felt the most stressed at exam time in school were 23% more likely to have severe acne.

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.

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.

While many people attribute breakouts to stressful situations, there is no evidence of stress directly leading to acne. In fact, sometimes the connection is reversed, as stress is often caused by acne breakouts. You should consult a dermatologist for more information.