Stress and Acne

Psychological stress can have such a major effect on our skin that an entire field of study has been developed to learn how the mind relates to the skin. This field is called psychodermatology and new breakthroughs in understanding skin disease have resulted from this connection. The association between acne and psychological stress is one connection that has been uncovered.

Acne and stress can have a bidirectional relationship,^[1] meaning that both can cause and be caused by the other.  Acne can cause a substantial amount of psychological stress.^[2-4] It lowers emotional well-being,^[5] is associated with depression,^[6]  and in some cases even suicidal ideation.^[7] The extent of stress appears to be related proportionally to the length^[8,9] and severity of acne.^[10]

On the other hand, stress can worsen acne as well. A study among Chinese high school and college students showed that negative life events can increase the frequency and worsen the symptoms of acne.^[1] Another study surveyed 1,375 young French people with acne and found that 30% more of the people with acne stated they were stressed every day compared to those without acne.^[3] Acne affected their sex lives.^[3] Eye tracking technology demonstrated that people with acne tend to fixate more on acne lesions on the faces of others.^[8]

 

How Does Stress Actually Worsen Acne Symptoms? 

When we become stressed, our bodies undergo a number of changes. These stress responses are most often thought of in terms of increased blood pressure or heart rate, but there are also hormonal fluctuations that happen. One example is that cortisol levels can increase, which can affect the metabolism of sugars, fats, and proteins, and can also decrease the immune system. These changes can happen all throughout our bodies, including our skin. 

Stress hormones are known to play an important role in the development and control of the sebaceous glands (oil-producing glands in the skin).^[11,12] Stress hormones, such as cortisol and the corticotropin-releasing hormone, can increase sebum production.^[13,14] An increased production of sebum can cause a blockage of the skin pores. This can lead to a backup of oil and cells, and later bacteria and inflammation, which can cause a pimple to develop. Substance P is another stress-related signal that can trigger sebaceous glands to produce more lipids (oils).^[15] 

For those who are prone to developing acne, it would be beneficial to incorporate stress relief practices, as these may be helpful. One study found that biofeedback based relaxation techniques helped improve acne.^[16] With the growing number of studies that have evaluated the use of medications, more studies are needed that evaluate stress reduction techniques and acne. 

 

1.    Wen L, Jiang G, Zhang X, et al. Relationship between acne and psychological burden evaluated by ASLEC and HADS surveys in high school and college students from central China. Cell Biochem Biophys.2015;71(2):1083-1088; PMID: 25331674.

2.    Su P, Chen Wee Aw D, Lee SH, et al. Beliefs, perceptions and psychosocial impact of acne amongst Singaporean students in tertiary institutions. J Dtsch Dermatol Ges.2015;13(3):227-233; PMID: 25721632.

3.    Misery L, Wolkenstein P, Amici JM, et al. Consequences of acne on stress, fatigue, sleep disorders and sexual activity: a population-based study. Acta Derm Venereol.2015;95(4):485-488; PMID: 25365961.

4.    Koo JY, Smith LL. Psychologic Aspects of Acne. Pediatric Dermatology.1991;8(3):185-188.

5.    Parna E, Aluoja A, Kingo K. Quality of life and emotional state in chronic skin disease. Acta Derm Venereol.2015;95(3):312-316; PMID: 24978135.

6.    Kubota Y, Shirahige Y, Nakai K, et al. Community-based epidemiological study of psychosocial effects of acne in Japanese adolescents. J Dermatol.2010;37(7):617-622; PMID: 20629827.

7.    Niemeier V, Kupfer J, Gieler U. Acne vulgaris--psychosomatic aspects. J Dtsch Dermatol Ges.2006;4(12):1027-1036; PMID: 17176410.

8.    Lee IS, Lee AR, Lee H, et al. Psychological distress and attentional bias toward acne lesions in patients with acne. Psychol Health Med.2014;19(6):680-686; PMID: 24471444.

9.    Do JE, Cho SM, In SI, et al. Psychosocial Aspects of Acne Vulgaris: A Community-based Study with Korean Adolescents. Ann Dermatol.2009;21(2):125-129; PMID: 20523769.

10.    Tasoula E, Gregoriou S, Chalikias J, et al. The impact of acne vulgaris on quality of life and psychic health in young adolescents in Greece. Results of a population survey. An Bras Dermatol.2012;87(6):862-869; PMID: 23197205.

11.    Chen WC, Zouboulis CC. Hormones and the pilosebaceous unit. Dermatoendocrinol.2009;1(2):81-86; PMID: 20224689.

12.    Chiu A, Chon SY, Kimball AB. The response of skin disease to stress: Changes in the severity of acne vulgaris as affected by examination stress. Archives of Dermatology.2003;139(7):897-900.

13.    Nikolakis G, Zouboulis CC. Skin and glucocorticoids: effects of local skin glucocorticoid impairment on skin homeostasis. Exp Dermatol.2014;23(11):807-808; PMID: 25056134.

14.    Zouboulis CC, Böhm M. Neuroendocrine regulation of sebocytes – a pathogenetic link between stress and acne. Experimental Dermatology.2004;13:31-35. 

15.    Toyoda M, Morohashi M. Pathogenesis of acne. Medical Electron Microscopy.2001;34(1):29-40.

16.    Hughes H, Lawlis GF, Brown BW, et al. Treatment of acne vulgaris by biofeedback relaxation and cognitive imagery. Journal of Psychosomatic Research.1983;27(3):185-191.