STRESS ACNE

Stress Acne Is Real — and Why You May Be Breaking Out Right Now

Dermatologists weigh in on the effects stress can have on your skin — and what to do about it.
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At this point, it is not an exaggeration to say that we are all living in a time of unprecedented stress. While the global coronavirus pandemic continues to evolve and our collective feelings of uncertainty about the future continue to mount, it's easy to feel helpless. Which is why we'd argue that now, more than ever, it's important to practice what we at Allure always advocate: Taking care of yourself.

Of course, stress manifests itself in many ways and everyone experiences it differently, but for the purpose of this story, we're talking about stress acne. Not the stress-induced pimple that pops up right before a big test in school or presentation at work. Rather, the kind of impact that long-term feelings of underlying stress, coupled with universal uncertainty in the world, can have on our skin.

"The relationship between psychological stress and the physical appearance of skin is affected by complex interactions across the body," explains Evan Rieder, a board-certified physician who specializes in both psychiatry and dermatology in New York City. In short: "Stress can cause many skin conditions to worsen," he says.

For more information on the link between stress and breakouts, plus some of the best ways to deal with, treat and prevent stress acne, we tapped a pool of skin and psychiatric experts. Here's what they had to say.

Why do feelings of stress show up on our skin?

"First of all, stress never makes anything better, and lots of skin conditions including eczema, psoriasis, and acne can flare with stress," explains Shari Marchbein, a board-certified dermatologist in New York City. "Pimples, whether large cystic lesion or small comedones, are caused by a combination of four things."

Those four things include bacteria (called c. acnes), general inflammation, plugged-up pores, and hormones — which is the key factor associated with stress-induced acne. Specifically, a hormone called cortisol, "which increases in the blood at times of stress or with lack of sleep," is responsible for triggering breakouts, Marchbein explains.

"Your body reacts to stress by elevating certain hormones, such as cortisol, to put it in a state of 'fight or flight,'" explains Janelle Vega, a board-certified dermatologist in Coral Gables, Florida. "The oil glands in the skin actually have receptors for this hormone, so an increase in stress will increase the formation of oil in the skin."

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But that's not all — acne is also largely influenced by general inflammation, and stress messes with that, too, specifically by directly increasing "inflammatory mediators" in the skin cells, Vega explains. Moreover, feelings of stress have a general depressive effect on the body's immune system, which "may make your acne worse by lowering your body's ability to fight inflammation," explains Sandra Lee, a board-certified dermatologist based in Los Angeles. (You may also know her as Dr. Pimple Popper.)

Additionally, feelings of stress can even cause us to treat our skin differently from the outside, in. For some people (myself included), when the outside world feels too stressful to bear, for too long a period of time, we might neglect our normal skin-care routines — or forgo it altogether. For others, stress can manifest in touching the skin more frequently or aggressively.

"Acne is exacerbated by picking [the skin], and picking is usually stress-triggered," Lee explains. "Oftentimes we pick at our skin and don't even realize we are doing it [because] we are deep in thought stressing about something else."

Not only will picking the skin exacerbate existing breakouts, but it also carries "a definite risk of causing permanent scarring," Lee explains. "So it's important to stop doing this, but it's difficult because it's often closely related to stress."

For all of these reasons, stress-induced breakouts manifest in many different forms, so it's "impossible to generalize" about exactly how it will present itself (i.e. as blackheads or pustules or cysts), Marchbein explains, though she does note that cystic acne is "especially common with stress."

How to cope with — and tame — stress breakouts

"Keeping routines can be profoundly helpful in times of unprecedented stress and uncertainty," Rieder says. "When we have seemingly lost control of [many of] the elements that give us peace, including our occupations, finances, and health, normalcy in any sense is welcome [and] things that we take for granted and often do automatically are important to maintain."

Perhaps number one on this list is sleep — both getting enough of it and also trying to stick to regular sleep-wake hours. Sleep is crucial to our health for many, many reasons, however, as pertaining to overall skin health, the importance of getting your Zzz's ties back to cortisol. This is because when we're sleep-deprived, our bodies produce an increased amount of cortisol, which, as previously established, can spiral our skin out of balance.

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Next on the list of important routines to maintain is "eating regular meals [and] having dedicated time both to yourself and for socializing, exercising, and practicing self-care in the way that you best respond to," Rieder explains. In terms of self-care, he personally recommends activities like meditation, yoga, deep breathing, exercise, and skin care, but the entire idea here is to take the time — regularly — to take care of yourself in a way that feels good to you.

It's also worth noting that one factor that can be both a source of self-care and stress is technology. While streaming an online exercise class is a highly recommended form of self-care among all the experts we spoke to, spending too much time on your phone or computer is not — especially when it feels like terrifying news updates pour in on an hourly basis. Still, it's also important to stay informed.

Again here, it's about striking a balance that feels right to you and prioritizes your mental health. Rieder's recommendation: "Find one or two news sources that are trustworthy and spend no more than 30 minutes daily informing yourself," he says.

"It is easy to get attached to your only source to the outside world — your phone and television — during a time like this," Vega agrees. "While it is good to be connected, you also need to detox from the overwhelming stress of the world in general."

The best topical treatments to treat stress acne

When it does spring up, stress pimples respond best to a few specific topicals: salicylic acid, benzoyl peroxide, and retinol, Marchbein and Vega explain. Each ingredient works in different ways to combat breakouts. Salicylic acid can unclog pores, benzoyl peroxide is anti-inflammatory and antibacterial, and retinol increases skin cell turnover rate.

That doesn't mean that you should use all three at once, however. Instead, Vega recommends using retinol as a long-term solution, and keeping either a salicylic acid or benzoyl peroxide product in your medicine cabinet to use as a spot treatment as needed.

Pimple patches can also be used as a spot treatment for acne, Marchbein suggests. "These are hydrocolloid adhesive stickers that contain certain active ingredients such as salicylic acid and/or tea tree oil, which are delivered to the pimple while it’s in place," she explains. "By occluding the pimple, these active ingredients are able to penetrate the skin more deeply allowing them to potentially work better."

For large, painful acne, "I would typically recommend heading to your dermatologist for a steroid injection to reduce the pain and inflammation of cystic breakouts," Marchbein explains, however, "at this point, medical visits should be for true emergencies only."

If you do find yourself reaching for, touching, or picking at your skin more often than normal, Lee suggests covering trouble spots with a bandage, "or better yet, apply an acne spot treatment, a dollop of cream right over the pimple or the red bump," she says. "If you reach up to pick at the bump, you will be reminded that there is cream on the area and hopefully this will remind you to not pick at your skin."


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