Stress Acne: What Causes It and How It Differs From Other Acne

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.

Stress can affect a person’s hormonal balance and the skin’s immune function. This may increase the chance of oily skin and clogged pores.

The last few years have been stressful as hell (a global pandemic, war, political divide, climate change…need I go on?), and if you’re like me, your skin probably shows it. Stress acne—i.e. breakouts brought on by stress, pressure, and feelings of anxiety—is a very real thing that most of us either deal with constantly (hi), or during moment when we’re feeling especially strained. And as anyone who has dealt with stress acne knows, the constant cycle of unexpected breakouts, followed by a billion spot treatments and acne products, followed by even more skin stress, just breaks you out all over again. Fun times.

It’s not all doom and gloom through. Because so many of us deal with stress acne, dermatologists and skin experts are exceptionally well-versed in treating it. So if you’re experiencing whiteheads and under-the-skin cysts because of stress, you’ve got options—and I’m here to break them down for you. Ahead, all the expert-approved ways to prevent and get rid of stress acne before it messes with your sanity once again.

Can acne be caused by stress?

Yes, acne can absolutely be caused by stress. Here’s the gist: When we experience stress and anxiety, a hormone called cortisol spikes within our bodies. The occasional spike in cortisol is totally normal, but elevated cortisol levels for days, weeks, and even months at time is what leads to acne. “In modern life, most people experience chronic stress, which means their bodies are constantly being flooded with high levels of cortisol—and it’s horrible for our skin,” Dr. Wechsler previously told Cosmo.

When we’re feeling stressed, our bodies also release more of something called substance P, or SP, which is a neurotransmitter found in nerve endings of the skin. Substance P can cause oil glands to overproduce sebum, leading to clogged pores and breakouts, and also increase inflammation in the body. And ICYMI, inflammation is the root of all skin evils: “Any inflammatory skin disease, including psoriasis, eczema, rosacea, can be worsened by stress,” says Dr. Harper.

What does stress acne look like?

Unfortunately, there’s no way to look at a patient’s skin and determine if their acne is caused specially by stress or something else, says Dr. Harper. Stress acne can often look the same as acne that’s caused by poor diet, hormone fluctuations, or a bad reaction to skincare. “There’s no specific location on the face or body that stress acne appears either,” says Dr. Harper.

That said, Dr. Harper told me that the majority of her patients who are experiencing acne along with stress have more nodules or inflammatory papules (think: red bumps and cysts) as opposed to blackheads and whiteheads. So if you’re seeing angry, inflamed breakouts and you’ve been feeling more overwhelmed and anxious than usual, there’s a good chance your acne is stress related.

Who gets acne?

According to the American Academy of Dermatology Association (AAD), acne is the most common skin condition in the United States, affecting up to 50 million people annually.

Acne occurs due to clogged pores, and scientists believe hormones play a role in its development. It usually begins in puberty and affects many adolescents and young adults. However, the AAD explains that it can occur at any stage of life:

• Neonatal acne: This type of acne occurs in around 1 in 5 newborns, usually appearing between the second and fourth weeks of life. It goes away on its own without causing scars and does not increase the risk of developing severe acne later in life.
• Infantile acne: Rarely some children develop acne between 3 and 6 months of age. It may cause deep acne nodules and cysts and lead to permanent scars.
• Teenage acne: The most common type develops during puberty due to androgens hormones increasing the size of the skin’s oil glands.
• Adult-onset acne: This is most common among females going through menopause and those with polycystic ovary syndrome due to fluctuating hormone levels. However, it can also occur in males and may develop as a side effect of medication or hair and skin products.

Additionally, other factors may cause or worsen acne. These include:

• family history
• age
• medications
• smoking
• diet
• environmental irritants
• pressure from sports helmets, tight clothes, or backpacks
• stress

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.

acne by stress?

Yes, acne can absolutely be caused by stress. Here’s the gist: When we experience stress and anxiety, a hormone called cortisol spikes within our bodies. The occasional spike in cortisol is totally normal, but elevated cortisol levels for days, weeks, and even months at time is what leads to acne. “In modern life, most people experience chronic stress, which means their bodies are constantly being flooded with high levels of cortisol—and it’s horrible for our skin,” Dr. Wechsler previously told Cosmo.

When we’re feeling stressed, our bodies also release more of something called substance P, or SP, which is a neurotransmitter found in nerve endings of the skin. Substance P can cause oil glands to overproduce sebum, leading to clogged pores and breakouts, and also increase inflammation in the body. And ICYMI, inflammation is the root of all skin evils: “Any inflammatory skin disease, including psoriasis, eczema, rosacea, can be worsened by stress,” says Dr. Harper.

How do you get rid of stress acne?

The easiest, most effective way to get rid of stress acne is with a combo of skincare and stress-reduction techniques. Here, a quickie breakdown of the best options:

Prescription retinoids:

There’s no better topical prescription than a retinoid for treating stress acne, or any kind of acne for that matter. Retinoids work on a cellular level to kickstart your skin’s renewal process—a must for clear, healthy skin. There are a ton of different retinoids for acne to choose from, but Dr. Harper likes Aklief (a potentially gentler retinoid known as trifarotene) and Twyneo (a tretinoin and benzoyl perxoide combo) best.

I personally use Altreno (a lotion-based tretinoin) for my hormonal, stress-induced breakouts and have had great results. I recommend talking to your dermatologist to see which retinoid will work best for you and will be potentially covered by insurance. If you don’t have insurance or don’t have access to a derm, look into Curology or Apostrophe. Both companies offer virtual doctor’s appointments and prescription-strength retinoid creams (and even oral antibiotics), minus the insurance drama.

Over-the-counter skincare:

If you’re not ready to go the prescription route, try using over-the-counter skincare products (like my favorites below) that are formulated with salicylic acid, benzoyl peroxide, sulfur, and/or azelaic acid, all of which can help treat stress acne. When used in cleansers, serums, masks, and spot treatments, these ingredients can help unclog pores, kill acne-causing bacteria on the skin, and minimize inflammation over time.

Causes & Prevention

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.”

Treatments

“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.”

Depending on the person and the severity of the condition, they may use the following treatments:

• topical medications, including antibiotics, benzoyl peroxide, retinoids, salicylic acid, or sulfur
• oral medications such as antibiotics or corticosteroids
• hormone therapy
• laser and light therapies
• superficial chemical peels or surgical procedures to treat scarring

Tips for managing acne

The National Institute of Arthritis and Musculoskeletal and Skin DiseasesTrusted Source advises that people living with acne can help take care of their skin by:

• cleaning the skin gently with a mild cleanser morning, evening, and after exercise
• shampooing hair regularly
• avoiding rubbing or touching acne lesions
• shaving carefully
• using sunscreen and avoiding sunburn
• choosing oil-free and noncomedogenic cosmetics
• talking with a doctor if they feel anxious about the condition

How to manage stress

Most people deal with everyday stress, but to handle it positively, experts suggest the following for a person:

• taking deep breaths or doing a breathing meditation to calm the body and mind
• taking time for themselves
• getting enough sleep
• eating a healthy diet
• engaging in physical activity or exercise
• talking with friends or family members
• volunteering in the local community to make friends and feel good about helping others
• using lists to be organized
• trying not to deal with stress in unhealthy ways, such as overeating, drinking alcohol, or using drugs or cigarettes
• getting help from a mental health professional if they need it

Stress-reduction techniques:

When it comes to treating stress acne (or any skin condition), it’s important to address the root of the problem—and in this case, that’s stress. Skincare can only do much on its own, so making it a point to commit to an activity or practice that helps alleviate stress and tension in your life is a must if you *really* want to get rid of your stress acne.

There’s emerging science that shows regular meditation can help keep cortisol levels stabile and acne in check, but any sort of stress-reduction technique—whether it’s walking a walk or listening to a soothing playlist—can honestly make a difference. “Stress-release techniques are anti-inflammatory, said Dr. Wechsler, who practices psychodermatology, a field of medicine that combined mental health treatments with skincare routines. “By minimizing your body’s inflammatory response to stress, you can improve the quality of your skin barrier, smooth and plump the skin, and reduce things like acne.”

Back To Blog.