It’s a common experience: You’re feeling stressed out about work, family issues, relationships or something else. Then to add insult to injury, a giant pimple appears.
Anyone who’s been there knows that the link between the skin and stress is undeniable. But what exactly is going on with the skin — the body’s largest organ — when we feel this way? HuffPost asked dermatologists to break it down.
Stress elevates cortisol levels
“Stress can have a profound effect on the body, including our skin,” said Dr. Nkem Ugonabo, a dermatologist and assistant professor at Albert Einstein College of Medicine. “It leads to the release of hormones such as cortisol, which leads to a cascade resulting in increased inflammation in the skin.”
Widely known as the body’s “stress hormone,” cortisol wreaks havoc on the skin barrier ― the part of your skin that keeps in good things like water, and keeps out bad things like irritants and allergens ― so that it can’t function as well.
“Hormonal changes like elevated cortisol can worsen existing skin conditions like acne, eczema, psoriasis or rosacea by increasing oil production and inflammation,” said Dr. Joyce Park, a dermatologist at Skin Refinery and the creator of Tea with MD.
If you’ve ever experienced “stress acne,” you know the connection between the skin’s appearance and inner feelings of pressure or anxiety. This is particularly common among those who are already prone to breakouts, as stress hormones lead to the overproduction of an oily substance known as sebum.
“Elevated cortisol in particular is associated with pimple formation and acne because steroids like cortisol stimulate sebum production,” said Dr. Karan Lal, a dermatologist with Affiliated Dermatology. “It also weakens your skin microbiome, allowing acne-causing bacteria to grow. Cortisol also leads to clogging of pores, also known as comedone formation.”
The brain-skin axis may set off a vicious cycle
“The brain-skin axis is a bidirectional pathway that can explain how stress can manifest on the skin,” said Dr. Gloria Lin of Schweiger Dermatology Group. “It is important to note that this is a two-way street. Psychological stressors can have effects on the skin, but the skin can also be exposed to stressors from the outside world and cause feedback to the brain that can then worsen the psychological stress.”
This can start a vicious cycle of stress from both ends of the brain-skin axis, which may ultimately worsen the negative effects on the skin. Lin noted that chronic stress tends to have serious, long-term effects, though small doses of acute stress can lead to issues too.
“Stress can cause the activation of the hypothalamic-pituitary-adrenal (HPA) axis, which is an important mediator of the body’s stress response,” Lin explained. “It can cause the downstream release of cortisol, the primary stress hormone, from the adrenal glands. In addition, catecholamines like epinephrine, which is part of the ‘fight or flight’ response of the body, are also released. These can stimulate the release of pro-inflammatory cytokines, which are signaling proteins that are responsible for cell-to-cell communication, leading to downstream inflammation.”
This pathway can launch the activation of mast cells, for example, and these can cause your skin to feel itchy. Dryness and redness are other potential effects.
Stress can accelerate skin ageing
“Stress can negatively impact how the skin ages,” said dermatologist Dr. Mina Amin. “Stress hormones can lead to a breakdown of collagen and elastin in the skin, resulting in premature fine lines and wrinkles. As a dermatologist, I also commonly see hair loss due to stress.”
Indeed, prolonged periods of high cortisol levels can accelerate signs of aging like a loss of skin elasticity and the appearance of new wrinkles.
“Catecholamines and cortisol can lead to DNA damage and inhibition of DNA repair that will also lead to premature aging,” Lin said. “Stress can also increase reactive oxygen species that are free radicals that can damage the skin. Lack of sleep, which causes increased stress, has been shown to increase the rate of skin aging.”
There are other health implications
“Stress can slow wound healing due to increased circulation of cortisol,” said Dr. Courtney Rubin, a dermatologist and co-founder of Fig.1 Beauty.
Researchers have found that it often takes longer for injuries or surgical wounds to heal in patients who are stressed out, compared with those who have lower stress levels.
“The HPA axis is important for skin barrier repair, so when this is disrupted, then it can lead to delayed wound healing,” Lin explained. “The epinephrine pathway can also constrict the blood vessels and limit the oxygen and nutrient supply to the skin. There can also be an increased risk of infection due to impairment of the immune system from stress.”
Stress generally makes the skin more sensitive and vulnerable to infections. It’s not uncommon for acute stress to reactivate the virus that causes shingles. And chronic inflammatory skin diseases are more likely to get out of control.
“Some people may experience a variety of rashes such as eczema, hives and psoriasis,” Ugonabo said.
“As a dermatologist, I commonly see skin conditions such as rosacea, seborrheic dermatitis, eczema, psoriasis and alopecia areata worsen with stress, mainly due to the increase in inflammation,” Amin echoed.
You can help your skin get through stress.
There are steps you can take to deal with the effects of stress on your skin.
“I often tell patients that if they are stressed and their skin is suffering the consequences, try to simplify their skin care routine instead of using more products,” Park said. “Oftentimes more products only irritate the damaged skin barrier more. Focus on gentle cleansing, hydrating and repairing the skin barrier to minimize inflammation and maintain skin health.”
Dallas-based dermatologist Dr. DiAnne Davis recommended maintaining a skin care routine that not only protects your skin but also allows you to slow down, relax and practice self care.
Tackling the stress at the root of the problem can be even more helpful in this situation.
“Believe it or not, managing stress is a key part of your skin care routine,” Amin said. “My favourite methods of relieving stress include meditation, yoga and breathing techniques, which can all contribute to decreasing stress and ultimately helping your skin.”