Can stress cause acne?

Figuring out which comes first – stress or acne – is a bit of a chicken-or-egg scenario. For years, researchers have documented the mental and emotional toll acne can have, but new studies are focusing on the role stress can have in triggering this skin condition.

Acne affects between 50% and 80% of adolescents and adults.1 Hormones, bacteria, and other physiological forces are often responsible for breakouts, but researchers have recently established a clearer link between emotional stress and acne of all kinds.1

In one study, 67% of Australian medical students reported stressful events before an acne outbreak, and up to 82% of Koreans in two other studies reported the same.1 For students, relationships and exam schedules were often to blame, but stressful life events and sleep changes were common stressors reported before acne outbreaks at all ages in several reports.

However, it is not just the development of acne that is linked to stress. Some reports have also linked higher stress levels to more severe acne breakouts, despite not having increased sebum production during these times. Other studies debate this correlation, suggesting that stress tolerance and coping skills — not stressful events themselves — have the greatest impact on acne severity.

While new studies don’t deny the role of stress in triggering acne breakouts, some research suggests that there are times when stress plays a bigger role. For example, stress is a commonly reported trigger in acne in adult women, with 83.2% of adult women with acne reporting moderate stress and 15.5% reporting high levels of stress.1 Stress at work in particular was blamed for acne breakouts by around 23% of women.1

Increased social pressure has only made the problem worse, the study continues, noting that stress-related female acne has increased in recent years. The study attributed about 50% of acne breakouts in women between the ages of 25 and 40 to stress.1

From a physiological perspective, other reports have explained exactly how stress translates into skin changes. Stress can increase levels of substances or processes in the body such as:2

  • Neurotransmitters
  • Cytokines
  • Hormones
  • Cortisol
  • Glucocorticoids
  • Inflammation
  • Genetic expressions

All of these may play a role in one way or another in the direct development of acne or in increased production of skin oils or inflammation, the study reports.2

A 2019 study took the examination of a link between stress and acne one step further, by testing stress-relieving measures as an acne treatment. Specifically, the study tested the Pythagorean Self-Awareness Intervention (PSAI) tool, a daily memory and mindfulness exercise. After eight weeks of use, the study found that over 93% of people in the treatment group saw an improvement in their acne, compared to around 27% in the control groups.4

References:

1. Jovic A, et al. The impact of psychological stress on acne. Acta Dermatovenerol Croatian. 2017;25(2):133-141.https://hrcak.srce.hr/file/272775

2. Branisteanu DE, et al. Acne in adult women: Clinical and therapeutic particularities (Review). Experimental and therapeutic medicine. 2022;23:151. doi: 10.3892/etm.2021.11074. https://www.spandidos-publications.com/10.3892/etm.2021.11074

3. Chatzikonstantinou, F., Miskedaki, A., Antoniou, C., Chatzikonstantinou, M., Chrousos, G. and Darviri, C. (2019), A novel cognitive stress management technique for acne vulgaris: a short report of a pilot experimental study. Int J Dermatol, 58: 218-220. doi:10.1111/ijd.14227.

4. Zigkiri ES, Nicolaides NC, Bacopoulou F, et al. The effect of the Pythagorean self-awareness intervention on psychological, lifestyle, and cognitive measures in a community sample. J Mol Biochemistry. 2020;9(1):32-40. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7842312/#

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