Can Stress Cause Acne?

Answer: Yes. Stress can trigger and/or worsen acne symptoms.

It is well known that putting an organism under stress makes it more susceptible to infection. This is true for humans, animals and even plants. The same neural and biochemical pathways that make stress feel uncomfortable can also disrupt the delicate balance of a properly functioning immune system, which increases your susceptibility to acne.

In the words of the experts:

“Activation of neurohormones by psychological stress occurs largely via the hypothalamic (pituitary) adrenal (HPA) axis, with subsequent upregulation of key stress hormones, such as corticotropin-releasing hormone (CRH), ACTH, and glucocorticoids (Cacioppo et al., 1998; Glaser and Kiecolt-Glaser, 2005). Via these stress-related hormones, accompanied by additional stress response mediators such as neuropeptides or neurotrophins (Webster, 2002), immune responses are profoundly altered (Glaser and Kiecolt-Glaser, 2005). For example, glucocorticoids inhibit the production of IL-12, IFN-y, and tumor necrosis factor by antigen-presenting cells and T helper 1 (Th1) cells but upregulate the production of IL-4, IL-10, and IL-13 by Th2 cells (Wonnacott and Bonneau, 2002).”Arck, et al. 2006.

To summarize that for non-scientists:

Stress causes changes in hormonal balance and that negatively impact your immune system. These changes appear to suppress immune functions that encourage the direct killing of pathogens (like the acne-causing Propionibacterium acnes bacteria), instead shifting the immune response to a more passive approach.

Glucocorticoids and Stress

One of the most well known stress hormones is cortisol (aka hydrocortisone). Cortisol is released by certain tissues in the body in response to stress. Many people have heard the claims on late night infomercials about the effect of stress on weight gain (and how they have a product that can fix it).

Specifically, these infomercials are referencing research that shows that stress induces the release of a molecule called cortisol, which can potentially induce the growth of adipose cells (fat cells). Cortisol is part of a group of molecules called glucocorticoid steroids (corticosteriods). These molecules have many functions, but one of their primary functions is to suppress the immune system.

The release of corticosteroids by the body in response to stress could explain why immune function is diminished in stressed individuals. Corticosteroids are often medically administered to treat severe allergic reactions (eg. poison oak) and inflammation. Corticosteroids are also occasionally injected directly into acne nodes and cysts in order to immediately reduce inflammation. However, because corticosteroids have a suppressive effect on the immune system, long-term use of these mediccations is generally discouraged.

Stress and Acne Symptoms

The hormonal changes that are induced by stress can cause or worsen acne symptoms. Stress can increase the production of sebum by sebaceous glands and suppress the immune system. This combination of effects provides conditions that increase the likelihood of acne. It is well-known that stress relief and relaxation can improve overall health. This also applies to acne. Decreasing psychological and physical stress (e.g. binge drinking, high-sugar diets, insufficient sleep, anxiety, drug use, injuries, etc) can improve acne and general health.

References

Neuroimmunology of Stress: Skin Takes Center Stage. Arck, et al. 2006.
Neuroendocrine regulation of sebocytes and a pathogenetic link between stress and acne. Zouboulis, et al. 2004.
Sebaceous glands in acne patients express high levels of neutral endopeptidase. Nakamura, et al. 2002.
The response of skin disease to stress: changes in the severity of acne vulgaris as affected by examination stressChiu, et al. 2003.
Stress, Acne and Skin Surface Free Fatty Acids. Kraus. 1970.
Exploring the relationship between stress and acne: a medical student’s perspective. Maleki, et al. 2018.
Effects of stress on immune function: the good, the bad, and the beautiful. Dhabhar, et al. 2014.
Exercise, immune function and respiratory infection: An update on the influence of training and environmental stress. Walsh, et al. 2016.
Repeated Social Defeat Stress Changes Peripheral Immune Status in Rats: Potential Effects on Basolateral Amygdala Function. Munchi, et al. 2017.
A systematic review and meta-analysis of the effort-reward imbalance model of workplace stress with indicators of immune function. Eddy, et al. 2016.
The effects of stress hormones on immune function may be vital for the adaptive reconfiguration of the immune system during fight-or-flight behavior. Adamo. 2014.