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Living in a world full of stress, work overloads, burnout, or just getting stressed before your exam or a special event makes you wonder if stress can cause acne breakouts? This article will share my knowledge about stress acne based on years spent in skin therapy.
Nowadays, stress acne is quite common. According to a study performed at the University of Melbourne, 67% of students identified stress as an exacerbating factor (1). In another study in Korea, 82% of respondents indicated stress as the main triggering factor for acne (2). As for adult acne, an extensive research study in France found that 41% of women had adult-onset acne, and half of these women stated stress as precipitating factor (3).
How Does Stress Induce Acne?
So now we know that stress can actually cause acne. In fact, it is one of the most important causes of adult acne.
How does this happen?
Stress increases the release of the stress hormone cortisol from the adrenal glands. Cortisol is a natural hormone that helps our bodies survive in a world full of triggers and react to stressful situations. It gives us energy in the morning, helps during exams or car accidents, and prevents getting sick very frequently.
Cortisol decreases the body’s immune system and the immune system of the skin. But when stress is prolonged and cortisol level remains elevated for a long time, it may affect many organs, including the skin. The skin barrier function gets impaired, and the skin becomes more susceptible to inflammation.
Also, decreased immunity disbalances your natural flora, and some fungi might overgrow. In this case, fungal acne may be present.
High cortisol levels can lower estrogen levels by affecting the cells of the follicles in the ovaries. The quality of oocytes decreases, and estradiol production is reduced (4). Therefore, the balance between estrogen and androgen gets impaired, increasing with androgens: more androgens, more acne breakouts due to increased sebum production.
In addition, adrenaline (epinephrine) released during stress takes out the moisture from not-so-vital organs, such as the skin, draws body fluids to the bloodstream (5), and elevates blood pressure for the immediate reaction to the stress. It resulted in skin dehydration and increased sebum oil production to replace the skin’s lost hydration. Increased sebum production due to epinephrine leads to stress acne.
Also, if you lack some vitamins, your cortisol levels might change. The B group vitamins are essential in controlling stress and maintaining healthy levels of cortisol. Check this article on vitamin deficiency and acne!
Some persons experiencing stress acne may start picking at their skin, sometimes without noticing it. It leads to skin inflammation, exposure to bacteria, infection, and scarring. Stress can also increase inflammation in rosacea because of the high levels of cortisol and adrenaline (epinephrine).
Rosacea is a skin disease that usually affects the cheeks and causes skin redness, inflammation, and pimples on the cheeks.
Cortisol is not the only hormone that can cause acne. If you are interested in hormonal changes and hormonal acne, read this comprehensive article on hormonal acne:
What Does Stress Acne Look Like?
Hormonal acne usually affects the jawline, chin, and sometimes cheeks. It is associated with hormonal changes during the month and often recurs on the exact dates of women’s cycles.
Stress acne can happen on any day of the month, regardless of hormonal changes during the period. It is triggered by emotional stress, work overloads, and other stressful factors.
Stress-induced breakouts usually appear on the oiliest skin in the T zone. Because of cortisol imbalances, sex hormones and androgens go up, and oil glands become active and produce more sebum. The skin looks greasier in stress acne, and inflammation may occur. Often stress acne is accompanied by itching and redness of the skin (which is not common in hormonal acne).
Other symptoms found in stress-induced acne include the dilation of pores, clogged pores, blackheads, whiteheads, papules (red bumps), pustules (pus-filled pimples), or in some severe cases, even cysts.
Did you know that not all black dots on the skin are blackheads? Read this article about blackheads and blackhead-like conditions to find out more.
How To Treat Stress Acne?
1. REDUCE STRESS
Yes, in all kinds of diseases, the first thing you need to do is avoid the causative agents. If you need to take care of somebody – take care of yourself first. If you are the one who does all the given tasks or wants to control everything or care about everyone, learn to say “No” sometimes.
If you are already experiencing a stressful situation, exercise to reduce your stress hormones and release endorphins, which will help you improve your mood and deal with stress. Yoga or breathing technique classes would be very beneficial.
Certain supplements can also help reduce stress, including magnesium, B complex vitamins, vitamin D, melatonin, ashwagandha, valerian, lemon balm, and chamomile.
The most potent known plant extracts to increase tolerance to stress are Eleuthero (Eleutherococcus senticosus), licorice (Glycyrrhiza glabra), and Rhodiola (Rhodiola rosea) extracts. It is best to alternate plant extracts with each other to avoid habituation.
Another great way to combat stress is to use aromatherapy, whether using essential oils or lighting a scented candle. The best soothing scents are lavender, chamomile, vetiver, lemon, clary sage, rose, and bergamot.
And together with aromatherapy, you could listen to relaxing music.
Reduce some stimulants, which may increase anxiety. For example, caffeine in coffee, tea, chocolate, cocoa, and energy drinks can increase stress.
Spend time with your family and friends, laugh (we all know that laughter can improve our mood and boost the immune system), watch some funny movies, or read a good book.
2. TREAT STRESS ACNE
The reasons for clogged pores and subsequent pimples are the overproduction of sebum and hyperkeratosis (the excess of keratin that sticks the dead skin cells together and clogs the pores), which leads to the growth of the Cutibacterium acnes (formerly Propionibacterium acnes) and inflammation.
If you want to keep your skin clean and remove the excess of dead skin cells, reduce inflammation, use cleansers or creams with salicylic acid. Salicylic acid is one of the best choices to combat acne, it has a potent anti-inflammatory and antimicrobial effect, exfoliates the skin, and works very well in minimizing hyperkeratosis.
If you have sensitive or irritated skin with stress acne or you get fewer breakouts, mostly whiteheads or blackheads, salicylic acid may irritate your skin, or you may break out more. Instead, you may try products with mandelic acid, which is milder to the skin, but still calms down the inflammation.
| Salicylic Acid | Mandelic Acid |
| Treats mild and moderate acne | Treats mild acne |
| Very strong anti-inflammatory and antibacterial effect | Mild anti-inflammatory and antibacterial effect |
| Not suitable for sensitive skin | Does not irritate sensitive skin |
| Lower percentages suit young teenagers | Best for young teenagers or the ones who want to start using acids |
| Best for hyperkeratosis, scaling skin | Mild effect on hyperkeratosis |
| Requires sunscreen | Requires sunscreen |
Look for cleansers, creams, masks that contain salicylic or mandelic acids.
Another choice for irritated skin with acne is to use products with natural active ingredients. One of the best natural ingredients is willow bark extract (Salix alba or Salix nigra), which contains salicin (the natural form of salicylic acid). Also, tea tree oil (Melaleuca Alternafolia), sulfur, zinc, turmeric/curcumin, clay, papaya enzyme, green tea, and neem are good choices.
For the spot treatment, I would recommend benzoyl peroxide. It has a very strong anti-inflammatory and antimicrobial effect. Some benzoyl peroxide products contain antibiotics or retinoids and require a prescription. But you can also find products containing benzoyl peroxide without prescription, only at lower concentrations. But for stress acne, those products will be strong enough.
3. CONTROL SEBUM
Since skin affected by stress produces more oil and looks greasier, controlling sebum secretion is key to preventing acne flares.
One of the best ingredients in sebum reduction is niacinamide, vitamin B3, which significantly lowers oil excretion (6). Niacinamide reduces inflammation and is helpful in inflammatory acne with papules and pustules. Allow at least 12 weeks for this ingredient do its job.
Another ingredient in cosmetics known for reduction of sebum production is green tea. In addition, green tea is a strong antioxidant, fights inflammation, has antimicrobial and anti-androgenic activity (7, 8).
A new emerging ingredient in decreasing sebum production is L-carnitine. It is an amino acid produced in the body, capable of breaking down fatty acids. Usually used in fat burning, L-carnitine significantly breaks down fatty acids in skin oil glands as well. You may look for topical cosmeceuticals or oral supplements containing L-carnitine (9).
4. HYDRATE SKIN
All organisms need water, and all skin types need hydration. If the skin gets dehydrated, it produces more oil to stay hydrated. More oil may clog pores. And the oil needs to pass through the oil glands. When skin is dehydrated, oil glands are not lubricated, and oil cannot easily pass through them. This process leads to acne breakouts.
Moisturizer will also prevent your skin from drying out due to the acne treatment, especially if you use various acids.
Best moisturizers for stress acne-affected skin should be non-comedogenic and oil-free. Look for non-comedogenic moisturizing ingredients best for oily or combination skin, such as Aloe vera, hyaluronic acid, sodium PCA, sorbitol, niacinamide (Vitamin B3), Vitamin C, argan oil, glycerin, hemp seed oil, propylene glycol, shea butter.
Avoid comedogenic products, such as algae extracts, carrageenans, coconut oil, flaxseed oil, hexadecyl alcohol, isocetyl stearate, octyl stearate, sodium lauryl sulfate, wheat germ oil.
5. AVOID UV RAYS
UV rays are hazardous to damaged skin because they may cause dark spots on those damaged areas and post-acne hyperpigmentation in a place of a pimple. People with skin of color are more at risk of developing post-acne hyperpigmentation.
Another reason to avoid UV rays is that many active anti-acne ingredients and prescription medications, such as isotretinoin or acids make the skin very sensitive to UV rays, and it burns faster.
Therefore, it is essential to wear sunscreen every day. Best sunscreens for oily or acne-prone skin should be non-comedogenic and ideally provide hydration or give a mattifying effect. Some sunscreens will also include anti-acne ingredients, so you won’t need a ton of products every day.
Some sunscreens may clog your skin pores. Avoid water-resistant sunscreens because they include oily ingredients. But if you still need water and sweat-resistant sunscreen, it is better to use a water-resistant mineral powder. Apply it on top of your non-water-resistant sunscreen. Active ingredients are physical blockers (titanium dioxide and zinc oxide) in those powders, which tend to be water and sweat-resistant. And it is very easy to reapply it!
Always wash your skin carefully after using sunscreens, especially if you use water-resistant sunscreens. Use a lightweight cleanser containing some emollients (oils) to remove water-resistant sunscreen containing water-repelling emollients. Water-based cleansers will not do the job properly on water-resistant sunscreens, and you may end up with clogged pores.
Takeaway
Stress is one of the most important causes of adult acne. Stress hormone cortisol reduces the skin’s immune system and imbalances the levels of androgens and estrogen. Adrenaline (epinephrine) causes dehydration of the skin, which leads to the increased production of oil.
Stress acne can happen on any day of the month and does not depend on hormonal changes during the cycle. It affects the T zone, and the skin looks oily and shiny, may itch, and be reddish.
If you want to combat stress acne, you need to avoid or reduce stress. Exercise, do yoga, sleep, take supplements, spend time with your family and friends!
Even if stress triggers your acne, bacteria are also involved. Use salicylic acid or mandelic acid products to prevent inflammation and pimples and exfoliate your skin. If you have sensitive skin, you may try products containing natural ingredients, such as willow bark extract, clay, niacinamide, zinc, and green tea. Remember to hydrate your skin and avoid UV rays to prevent higher sebum production and dark spots.
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ARTICLE SOURCES
- Green J, Sinclair RD. Perceptions of acne vulgaris in final year medical student written examination answers. Australas J Dermatol. 2001;42(2):98–101.
- Suh DH, Kim BY, Min SU, et al. A multicenter epidemiological study of acne vulgaris in Korea. Int J Dermatol. 2011;50(6):673–681.
- Poli F, Dreno B, Verschoore M. An epidemiological study of acne in female adults: results of a survey conducted in France. J Eur Acad Dermatol Venereol. 2001;15:541–545.
- Shilpa Prasad, Meenakshi Tiwari, Ashutosh N. Pandey, Tulsidas G. Shrivastav, and Shail K. Chaube. Impact of stress on oocyte quality and reproductive outcome. J Biomed Sci. 2016; 23: 36.
- Larrabee W.F. Jr., Lanier B.J., Miekle D. Effect of epinephrine on local cutaneous blood flow. Head Neck Surg. May-Jun 1987;(9)5:287-9.
- Draelos ZD, Matsubara A, Smiles K. The effect of 2% niacinamide on facial sebum production. J Cosmet Laser Ther. 2006;8:96–101.
- Suzana Saric, Manisha Notay, Raja K. Sivamani. Green Tea and Other Tea Polyphenols: Effects on Sebum Production and Acne Vulgaris. Antioxidants (Basel). 2017 Mar; 6(1): 2.
- Mahmood T, Akhtar N, Moldovan C. A comparison of the effects of topical green tea and lotus on facial sebum control in healthy subjects. Hippokratis. 2013;17:64–67.
- Reto I. Peirano, Tina Hamann, Hans-Jürgen Düsing, Mehdi Akhiani, Urte Koop, Thomas Schmidt-Rose, Horst Wenck. Topically applied L-carnitine effectively reduces sebum secretion in human skin. J Cosmet Dermatol. 2012 Mar;11(1):30-6.
A very professional article. Thank you very much
It was useful, read it with interest.