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Does stress cause acne?

Dr. Mehmet Oz, MD
Cardiology (Cardiovascular Disease)
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.

Stress is an important factor in most medical conditions, acne included. However, it's important to understand that stress doesn't cause acne it simply makes acne worse. Stress causes an increased release of cortisol, a stress hormone. Cortisol can influence other hormones in your body. And since acne is a mostly hormonal process, it can get worse.

Acne is a hormonal disease, largely driven by oil production in the skin. Stress causes and increase in the production of certain hormones in the body called androgens. These androgens cause the oil glands in your skin to raise the amount of sebum (natural oil) in your skin. For predisposed patients, this increase in oil can cause acne or worsen acne already present. So can stress make you break out? For sure.

Corey Schuler, MS, DC
Alternative & Complementary Medicine
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.

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).

Dr. Doris Day, MD
Dermatology
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.
100 Questions & Answers About Acne

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100 Questions & Answers About Acne

100 Questions and Answers About Acne provides you with all the information you need to manage your complexion problems. Written by Dr. Doris J. Day, a world-class expert in the field, this clearly...
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.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.