Does stress affect acne?

Does stress affect acne? This question has long been debated by dermatologists, medical scientists, and patients alike. Actually, as a practicing dermatologist and particularly interested in psychodermatology, I feel that this discussion is superfluous. The only thing that needs to be debated is how profound the effects of stress are on acne and vice versa!

Prolonged and uncontrolled stress and tension, anger and anxiety are the nemesis of good health in general and healthy skin in particular. If you are stressed, it will show on your skin first! Changes in blood flow due to emotional and neurological effects, continuous perspiration, neural irritability induced by the release of chemical mediators within the skin will make the skin itchy and irritated. Many stress-related diseases such as psoriasis, itching, hives, alopecia areata, atopic dermatitis, etc. manifests itself to damage the structure and integrity of the skin.

Does stress affect acne?

There is growing evidence that stress does affect acne, more profoundly than previously believed.

Many studies indicate that stress plays a very important role in causing, maintaining and aggravating acne. The largest study ever conducted on adolescent acne severity and stress levels by researchers at Wake Forest University School of Medicine and reported in the Acta Derm Venereolrevealed that adolescents who were under high levels of stress were 23 percent more likely to have greater severity of acne.

In another study published in the Archives of Dermatology, a team of researchers led by Dr. Alexa Kimball of Stanford University studied 22 college students with varying degrees of acne. They found that students had worse acne during exam periods, when they also rated their stress higher. The link remained even after other factors were taken into account, such as changes in hours of sleep, quality of sleep, diet and number of meals per day.

A similar study conducted among 19 college students by Chiu A et al., also published in the Archives of Dermatology, confirmed that increased stress levels were strongly correlated with increased acne severity.

Another study, published in the Proceedings of the National Academy of Sciences, detected a possible chemical relationship between stress, acne and other skin disorders. Stress causes the hypothalamus, a part of the brain, to release a chemical called corticotropin-releasing hormone (CRH). This study found that sebaceous glands in the skin respond to CRH through certain CRH receptors present on the gland’s oil-secreting cells. When CRH comes in contact with CRH receptors, the sebaceous glands are activated to produce more sebum, which induces an acne breakout.

In addition, the researchers also noted that the male hormone testosterone reduced the production of CRH receptors, while human growth hormones increased the production of CRH receptors. This may explain why men and women get new acne lesions at different ages.

Yes, the verdict is out: stress affects acne.

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