Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 1/26/2021
When you’re under emotional stress, you can feel it everywhere. Your appetite and sleep patterns change, you could feel sick to your stomach, experience headaches, or worse. And it wouldn’t be unusual to see a raging pimple or two.
The association between stress and physical health is obvious, and sometimes it creates a vicious cycle: Stress causes ill health, which causes more stress, and so on. Stopping this cycle requires you to manage your chronic stress and the physical symptoms of it, no matter what those symptoms might be.
In general, acne vulgaris is brought on by a combination of factors such as androgen (male hormone) production, sebum or oil production, the accumulation of dead skin cells (hyperkeratinization), bacteria known as propionibacterium acne (P. acne) and inflammation. Any one of these things, thrown out of whack, can cause an acne flare up. For example, increased androgen production in puberty or in hormonal disorders like polycystic ovarian syndrome (PCOS) can lead to acne. It’s a similar phenomenon that connects stress and acne.
Stress increases the production of adrenal androgens including the hormone known as cortisol (often referred to as the stress hormone). In turn, your sebaceous glands are stimulated to produce more oil, contributing to acne. It’s also believed this hormonal change can influence inflammatory processes, further contributing to acne and delaying wound healing, meaning your acne lesions could last longer.
All that said, it’s hard to say people who experience stress acne wouldn’t otherwise have acne breakouts — the stress-acne connection is a chicken-egg one.
Acne can cause stress. When you have a breakout or persistent acne, it can influence your mood. In fact, it may make you want to stay home and pull the covers over your head until your skin clears. And if it’s true that stress produces acne, you enter a vicious cycle.
A survey of several thousand women found that half indicated stress as a precipitating factor in their acne. In other words, they believe stress influences their breakouts. So if you’ve noticed a stressful week at work ends in a few new, raging pimples, you wouldn’t be alone.
Managing your mental health takes practice and time. Many of us work on it well into old age. But learning to better manage your stress levels can have benefits well beyond clearer skin. It can simply make life easier. The following techniques can help you reduce stress in your life:
Sleep. Getting enough sleep can make you more even-keeled and reduce stress levels.
Relax. Practice deep breathing and other relaxation techniques to reduce muscle tension, anxiety and blood pressure.
Eat healthful foods. Don’t self-medicate with food when you’re stressed out. The momentary feeling of reward is fleeting.
Exercise. Burn off stress regularly with daily activity. Exercise releases endorphins which act in the same manner as antidepressants! So get moving, even if it’s a few short walks in the sun each day.
There are numerous products available for the treatment of acne — some available over-the-counter without a prescription, and others that require a prescription from a healthcare provider. The following are solid choices, backed with years of research and a track record of effectiveness:
Benzoyl peroxide is an over-the-counter topical medication that you apply directly to your pimples or in a thin layer all over your face. You can get it in face washes, gels or lotions.
It works to kill the bacteria that causes acne, while reducing inflammation, the overabundance of dead skin cells, and the clogging of pores. It’s considered a go-to choice for mild-to-moderate acne. The most common side effects include redness, drying and peeling.
Available in both topical and systemic (oral) formulations, topical retinoids are considered the gold standard when it comes to treating acne. They’ve been used for decades and are often used in conjunction with other medications. Topical formulas such as tretinoin and adapalene, and oral versions such as isotretinoin are considered effective for inflammatory and more mild acne alike.
Both oral and topical antibiotics are sometimes used to treat moderate to severe acne, and may be paired with retinoids under the direction of a healthcare provider. These prescription medications work directly on the bacteria that causes acne, P. acnes.
Hormonal birth control pills can reduce androgen levels and help manage hormonal acne. Oral birth control can increase your risks of deep vein thrombosis, especially in women who smoke and who are over 35, so talk to your healthcare provider about whether this solution is a safe one for you.
Stress acne is a clear sign that the mind-body connection is real. Your physical health depends on your mental health, and vice versa. By working to manage your stress while taking care of your body, and talking with a healthcare provider if needed, you can get a handle on your acne and feel better in the end.
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