Can Acne Be Caused from Stress?

New clinical evidences have finally put to rest any doubt that stress does cause acne. However, it is still not clear how stress leads to the appearance of acne lesions. Another point of contention among dermatologists and researchers is whether stress causes or only worsens acne.

Some have even argued that acne breakouts distress sufferers enough to cause self-perpetuating acne-stress cycles in which both factors lead to each other.

Both positive and negative events can cause stress and acne breakout.

For example, a wedding and a death can cause comparable degrees of stress. Therefore, good or bad stressors can worsen acne. A bride can as well develop acne breakouts as any teenage student preparing for exams.

What is Stress?

The stress that causes acne is psychological stress with emotional stress as its main component although it can also be accompanied by some degree of physical stress.

Some of the presentations and causes of stress are:

• Feeling of overbearing pressure and anxiety
• Irritability, nervousness, panic attacks and insecurity
• Social withdrawal, exhaustion, lethargy, insomnia
• Disease conditions such as skin problems, migraine, menstrual problems, gastrointestinal problems, high blood pressure and other cardiovascular problems

Stress can either by external (introduced into the immediate physical or social environment) or it may be perceptual and determined by the internal, negative perception of a given situation.

Most of the health problems caused by psychological stress are due to the body’s response to the stressor.

To combat stress, the body calls on the sympathetic nervous system. The response of this system is mainly determined by the release of adrenal hormones.

These hormones then put the body’s resources into high gear.

Adrenal hormones cause the dilation of pupils; the release of endorphins which are natural painkillers; the constriction of the veins and the dilation of the arteries to supply more oxygen to cells; and the elevation of respiratory and heart rates.

These effects produce energy boosts and also cause reduced pain sensitivity, tensing of the muscles, stoppage of the digestive process, and rise in blood pressure.

All of these mean that the body is quickly using up resources while not producing more. It is a non-sustainable state which leaves the body open to attack from other sources (infections, for example). Furthermore, the rapid depletion of these resources cause the fatigue and diseases experienced with stress.

Clinical Evidence of The Link Between Stress and Acne

A common research method to access the effects of stress on the development of acne in adolescents is to recruit high school and college students for a clinical study just before the exam period.

Two studies that took this approach report very similar results.

In the first study published in Archives of Dermatology in 2003, 22 university students with acne vulgaris were examined for acne severity (using the Leeds acne scale) and stress levels (using the subjective Perceived Stress Scale questionnaire) over different periods of time when they were preparing for and writing examinations and also when there was no exams.

The result showed that the severity of the students’ acne worsened during examination periods which were also the periods of time during which they experienced the highest degree of stress.

In the second study, 94 high school students in Singapore were recruited and observed during their exam periods (high stress) and summer holidays (low stress).

The results published in Acta Dermato-Venereologica in 2007 showed that increased psychological stress worsened acne in these students. Curiously, there was no significant change in sebum production between the high stress period and low stress period.

The conclusion that stress does not cause acne by increasing sebum production was supported by a much earlier study published in the journal, Psychosomatic Medicine, in 1970.

The study confirmed that emotional stress was directly responsible for increasing the severity of acne lesions but that it does not increase the total surface lipids on the skin.

However, stress did increase the free fatty acids found on the skin surface.

How Stress Affect Acne

The Hormonal Link

Stress induces the production of a number of hormones in the body especially the adrenal hormones. Some of these hormones directly affect the sebaceous glands found in the skin and increase the production of sebum.

For example, the androgens produced from the adrenal glands bind to the androgen receptors found in sebocytes, cells of the sebaceous glands. There, they cause the proliferation of these cells and then the enlargement of the glands.

Once enlarged, these glands produce sebum in excessive amounts.

However, some studies into the effects of stress on acne have shown that sebum production is not increased significantly in stressed acne patients. In fact, most studies found that the total lipid levels on the skin surface did not change with or without stress.

However, androgens are not the only hormones released during stress that have receptors in sebocytes.

The cells of the sebaceous glands have receptors for other substances released during stress. The endorphins and corticotropin-releasing hormone (CRH) released during stress can bind to sebocytes too.

Actually, the sebocytes produce CRH themselves. However, when more is released from the hypothalamus, some of the activities of the sebaceous glands are accelerated.

When these hormones bind to the sebocytes, they do more than increase the proliferation of these cells and the enlargement of the sebaceous glands; they can release inflammatory cytokines too which contributes to the appearance of inflammatory acne lesions.

The Free Fatty Acid Link

While stress may not increase the secretion of sebum, it changes the composition of sebum by increasing some of its components.

There are 3 major fractions of lipids making up sebum. These are triglycerides; wax and cholesterol esters; and free fatty acids.

When stressed, the body increases the production of free fatty acids. Therefore, while the same amount of sebum still gets to the skin, during stress the sebum contains more of free fatty acids.

Free fatty acids have been shown to directly contribute to the appearance of acne comedones such as whiteheads and blackheads.

Free fatty acids are bad for the skin because they are quickly converted to other substances. The metabolism of these fatty acids release harmful free radicals on the skin. These free radicals then damage the skin and prompt inflammatory responses from the immune system.

Therefore, stress can worsen acne by causing inflammatory acne lesions through free fatty acids.

The Excoriation Link

Yet another link between acne and stress is purely psychological.

Since acne causes skin blemishes, some acne sufferers compulsively pick and squeeze pimples on their faces. This quickly leads to aggravation of the lesions which can turn a mild acne breakout into a severe one involving extensive scarring.

Studies have shown that when stressed, people are more likely to touch their faces and pick their pimples. These actions are initially caused by nervousness but can quickly develop into compulsion especially as the acne worsens.

This condition is called acne excoriee.

In extreme cases, some acne sufferers may actually pop all the pimples on their faces only to have scabs covering the area affected by acne. These scabs then quickly develop into extensive scarring which is even harder to remove.

The Healing Link

Lastly, stress has been shown to reduce the ability of the body to heal wounds by as much as 40%.

Since acne lesions are essentially wounds, it is quite possible that as the body dedicates most of its resources to combating stress, there are not enough healing factors to keep the development of acne lesions down. This then cause the worsening of acne.

How to Deal With Stress Acne

Stress acne cannot be treated with stress medications. Instead of taking to drugs some experts advice taking time out to relax and removing the immediate stressors.

To relax, you should sleep well at night, eat healthy diets and exercise moderately. You can also take on meditation or breathing exercises to relax.

For most people, when the cause of the stress is removed, their acne clears out soon after. However, you should not wait for your acne to clear with time but treat it immediately.

First, improve your skin hygiene by washing your face with warm water and a mild, non-irritant soap or cleanser. Do these in the morning and just before you go to bed.

Use an oil-free cleanser to remove excess sebum from your face and open up clogged pores too.

Lastly, you should keep on taking your acne medications. To avoid unwanted side effects while getting lasting benefits, you should try using natural acne remedies such as Actimine.