We’ve all dealt with a blemish at least once in our lives, and I would bet my life savings that the majority of adults reading this article will experience at least one more before the month is over. They can suck, but breakouts are just a normal part of having skin—which, you know, is something you generally want to have, particularly on your face. But, as an adult, there are times when acne breakouts can indicate a bigger issue, past the general explanation of clogged pores. Things like stress and hormones can cause acne breakouts—and if you’re experiencing repeated breakouts, this may be the explanation for why.

What Is Stress Acne?

“In times of stress, your stress hormones rise and trigger your oil glands to produce more oil, which then triggers acne flares,” Hart explains. Hormones also play a similar role, but according to Hart, the difference is timing.

If you find you mostly get breakouts around your period, you are likely experiencing hormonal acne rather than stress acne. “Hormonal changes, mainly increased androgen levels, have the same effects on oil glands,” Hart says. “The main way to tell the difference is to track acne triggers, for example, after a period of stress versus more regularly with monthly menstrual cycles.”

The location of stress acne may vary. If you find you’re normally breaking out in the same place around the same time of the month (e.g., your chin or jawline), you can bet that your acne is likely related to your menstrual cycle rather than your stress levels. This is especially true if the acne takes on the form of painful cysts. According to Green, these “usually appear in the same spot over and over again and become severely chronic because they’ve accumulated so much oil over days or even weeks.”

But stress acne, as opposed to other types of breakouts, will usually appear in the oiliest areas of your face. “[Stress] pimples or acne lesions typically appear on the T-zone,” Vaidian shares. “When this is the case, the acne is usually accompanied by dilated pores, shininess, blackheads, whiteheads, and uneven or grainy skin.” Regular acne, on the other hand, might not appear with these accompanying symptoms. Similarly, Green says that stress acne is often accompanied by telltale signs like redness and itchiness.

Causes & Prevention of Stress Acne

First things first: What causes stress acne? Stress, of course, but it’s a little bit deeper than that. According to a 2017 research review in The Journal of Clinical and Aesthetic Dermatology, “a self-administered, dermatologist-validated questionnaire of 3,305 women ages 25 to 40 years in France” revealed adult-onset acne was reported by 41 percent of the women, and that “stress was listed as a precipitating factor for acne in half of the women surveyed.”

So, how does stress actually relate to the cause of blemishes on your face? That’s where things get a little more complicated. “Emotional stress triggers an increased release of the stress hormone cortisol,” Vaidian explains. Increases in cortisol trigger a systemic response within the body that has the potential to impact the immune system, digestive system, reproductive system, and growth processes.

Cortisol is key in causing stress acne breakouts as well. “When cortisol levels rise, they disrupt levels of hormones that regulate sebum balance and result in clogged pores and development of acne,” Vaidian explains. In other words: More oil production means more clogged pores, and more clogged pores mean more breakouts.

Considering the involvement of cortisol, when we talk about stress acne, we’re talking about hormonal acne in a way as well. It’s not the same as acne that will show up around the start of your menstrual cycle, but it is acne that’s appearing because of a response to an alteration of your regularly scheduled hormonal pattern. “When you’re under an increased amount of stress, this can trigger hormonal changes that simply worsen your acne,” Green explains. “Stress acne can happen at any time, at any age. Usually, in adults it’s because they’re stressed at work or at home, in younger adults, it’s mostly because of school.”

Treatment of Stress Acne

“If you work with your skin, the results will be there one step at a time,” Green says. For treatment options, she recommends “a topical spot treatment, something like salicylic acid, which can be found over-the-counter.”

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What does stress acne look like?

Given the increase in oil production, she says your skin will usually look greasier and slightly more inflamed. Zeichner adds that stress acne can also look like a combination of blackheads, whiteheads, red bumps, and pus pimples.