I started dealing with acne in middle school, and by the time 8th grade rolled around, I made it my mission to see a dermatologist and enter high school zit-free. In reality, my breakouts didn't subside until my sophomore year, and I've maintained clearer skin since then with prescriptions and topical treatments. After college, I thought I could wash my hands of my nighttime retinol routine — but then the pandemic hit, and my skin went back to its old habits. I felt uncomfortable in my skin, not only because of the way it looked, but because my face was painful and itchy after going through the inevitable tretinoin purge for the second time.
According to the American Academy of Dermatology Association, acne affects about 50 million Americans a year, making it the most common skin condition. However, understanding what causes it in each person is unique. It also makes sense that a lot of us are noticing our stress levels and breakouts increase as we come up on a year of being affected by a pandemic, violence incited by racial fires stoked for centuries, and the transition of a new presidential administration. The past 12 months have been anything but predictable, and that goes for skin concerns as well.
Since it seemed like my skin was breaking out worse than it had in years during a particularly trying time, I asked the experts whether emotional turbulence can actually trigger acne — or if the apparent link was more of a coincidence than a true cause-and-effect situation.
So, what is stress acne?
As closely tied to your stress levels as your breakouts may seem, stress acne doesn’t actually have its own classification. Caroline Robinson, MD, founder of Tone Dermatology in Chicago, says that while there are recognized forms of acne like cystic and blackheads, stress-induced acne is really just one of the many ways your physical body might be reacting to your emotions. She explains that stress can cause various changes to our skin that manifest in the form of skin conditions, and acne is no different.
“There’s a strong relationship between stress and acne that has been established over the years, and from literature we know that acne can come about or even flare up in the presence of a stressful event," Dr. Robinson says. "Our stress levels can cause us to produce more androgens, the male-type hormones that all of us have that can contribute to a lot of different things and cause our acne to become worse.”
Dr. Robinson explains that stress-related acne tends to appear on the lower half of the face, and tends to be more inflammatory in nature and even cystic, rather than comedonal, as in blackheads and whiteheads. Dermatologists also take into account factors that make some people more prone to acne, like family history and skin type, particularly if you have oilier skin.
How can acne affect us emotionally?
Acne is deeper — no pun intended — than the physical manifestation of pimples, especially when you're already experiencing a heightened degree of stress. As a child and adult psychotherapist, Matthew Traube, MFT, specializes in the spectrum of emotions people experience surrounding skin conditions, including eczema, psoriasis, vitiligo, and acne. He’s learned that there are two kinds of relationships people tend to have with their skin: one that is all-encompassing in its negative effects, and one that is inconsequential in the patient’s daily activities.
“Some people have a very threatening relationship with acne, meaning when they get acne, they can feel like somehow they’re unloveable or aren’t going to achieve at work or somehow shouldn’t socialize," Dr. Traube says. "Now, other people and their relationship is less threatening. They get some acne and it doesn’t always make a big difference.”
While those people might carry on with their day and interact with others, Dr. Traube says that doesn’t mean their acne isn’t frustrating. He focuses his work on helping patients change their relationship with their skin by teaching his clients overall stress-management routines like exercising, getting enough sleep, and having a balanced diet.
What products can help treat it?
Dr. Robinson says using a cleanser with salicylic acid or an alpha-hydroxy acid like lactic or glycolic can help control excessive oil production that can lead to clogged pores and acne. CeraVe's salicylic acid line includes a cleanser, body wash, lotion, and cream to help exfoliate skin and smooth bumps. Innbeauty Project Pimple Paste uses potent ingredients like oregano and tea tree oil to shrink pimples overnight, and Alpha-H Triple Action Cleanser contains aloe to calm inflammation before layering on your topical treatments.
Clinical esthetician Danielle Gronich, co-founder of CLEARSTEM Skincare and owner of San Diego Acne Clinic, emphasizes what not to do when treating your acne: She recommends steering clear of drying isopropyl and SD alcohols, and only using retinoids in moderation to avoid irritation and the dreaded "purge." Gronich also urges against using hot water on your face. "This is not an ingredient, but it's something many people do every day, and it's terrible for both aging and acne because the heat causes daily inflammation that re-injures scar tissue and interferes with the healing process," she says.
Acne at any age can be a huge impediment to the way someone lives their life and perceives their own worth or beauty. Skin conditions need to be handled with respect and care, not only by doctors and estheticians, but by the people around you. Our body has a way of telling us something is wrong before we even know it, and stress manifesting as acne teaches us that there are routines we need to adjust. By listening to our body, we learn how to take care of it and embrace it.
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