Stress Acne Is Real: What It Is & What To Do About It

The hunt to find out what's causing your breakouts can feel like a never-ending goose chase. Especially with the increase in virtual conversations about acne triggers on social media, it can seem like a new cause pops up every other day that you should look into. 

Let's break down exactly how this takes place. Certain hormones released when we're stressed can trigger the body to produce more sebum—aka the waxy, sticky stuff that keeps your skin moisturized. "CRH (corticotropin-releasing hormone) is produced in the brain and is responsible for telling your adrenal glands to increase cortisol production during stressful times," notes board-certified dermatologist Joshua Zeichner, M.D., about acne. "CRH also has an impact on sebaceous glands in increasing oil production." 

Essentially the hormone that triggers cortisol also triggers sebum production. So as cortisol increases in the body, oil production does as well.

"This can lead to increased oil production1 [which clogs the pores], and these lesions tend to be inflamed and sometimes painful," board-certified dermatologist and founder of Hudson Dermatology and Laser Surgery Dhaval Bhanusali, M.D., FAAD, tells mbg. However, this isn't quite as instantaneous as it seems. 

"Cortisol levels rise about 15 minutes after the onset of any stressor and can take a few hours to return to normal. However, in most instances, we aren't just having one stressful event but rather a myriad of occurrences that lead up to stress; oftentimes these levels can take months to settle," board-certified dermatologist and founder of NicholsMD of Greenwich Kim Nichols, M.D., FAAD, explains. 

"As a result, it is tough to pinpoint how long it may take for a breakout to begin and last," she adds. Translation: Stress acne isn't exactly easy to spot. 

Stress acne often look very similar to any other kind of acne that you might get: It can come in the form of small whiteheads to large, angry cysts. Typically folks get whatever type of acne they normally get—it's just that stress was one of the triggers.

As plenty of dermatologists will tell you, salicylic acid is one of the best ingredients for managing breakouts. This ingredient is a type of exfoliant known as a beta-hydroxy acid or BHA, which is different from an alpha-hydroxy acid, or AHA. 

"Salicylic acid is oil-soluble and is able to penetrate deeper into the pores compared to AHAs," board-certified dermatologist Anar Mikailov, M.D., FAAD, founder of KP Away, said about the ingredient.

SA can even penetrate deep into the pores to help remove dirt, oil, and excess sebum. Hence, why so many acne products contain salicylic acid (or its natural form, willow bark extract) as one of the first ingredients. 

If you're not already using retinol in your skin care routine, you may want to consider adding it. You can go for over-the-counter retinol (like one of these top picks), or visit your dermatologist to learn about prescription-grade options if your acne won't budge. 

After retinol interacts with the skin's receptors, it beneficially alters the genes involved with inflammation and cell growth. This reduces the formation of microcomedones2, or skin pores clogged with sebum, bacteria, and dead skin cells. 

To ensure your skin care and makeup products aren't working against you, run them through the pore-clogging ingredients checker. Not every single ingredient listed on these scanners is guaranteed to clog your pores, but there's definitely a higher chance they could. 

Strong active ingredients like salicylic acid and retinol are great for easing breakouts, but they also can dry out the skin. Luckily, you can compensate by adding hydration back into your complexion via hydrating serums and moisturizers. 

Acne facials can help treat active breakouts, prevent future ones from happening (in part), and deeply hydrate the skin. These treatments often include extractions to unclog pores as well as targeted topical treatments with exfoliating ingredients like salicylic acid. 

An esthetician might also incorporate LED light therapy: specifically, blue LED light, which kills acne-causing bacteria, controls sebum regulation, and soothes the skin; or green LED light, which is hailed for reducing hyperpigmentation and calming redness. 

Say you've exhausted all of your possible over-the-counter options for acne and nothing has worked—don't fret too much. If you have access to a dermatologist, it's worth the trip. These professionals can help you pinpoint possible triggers for your acne and offer other treatment options you may not have tried. 

These include topical prescriptions (like stronger retinoids) or oral medications such as spironolactone (used off-label for hormonal acne treatment) or isotretinoin (formerly known as Accutane). 

Again, no matter what triggers your acne in the first place (products to hormones to genetics, and more), stress can make it worse. Relieving stress when you're breaking out isn't exactly easy, given that more pimples often cause more stress. 

Meditation has been shown to reduce stress and anxiety4. Some people shy away from meditation because they assume they wouldn't like it, but meditation is a versatile practice that can be tweaked and trimmed to fit your unique needs and practice. 

"Physical activity stimulates various brain chemicals that may leave you feeling happier and more relaxed. You may also feel better about your appearance and yourself when you exercise regularly, which can boost your confidence and improve your self-esteem," Goldfaden says. 

One thing that people often overlook on this topic is the fact that periods of stress often coincide with focusing on the problem at hand and thus, abandoning everything else going on in your life—on a less serious note, this could mean your skin care routine or drinking enough water.

Of course, you should tend to your stressors first and foremost, but if you're going to enter a period of extended stress or you find yourself in one right now (like finals week, a family event, relationship trouble, job hunting, etc.), try to make a boundary for yourself and commit to your daily skin care routine, if at all possible (a few more cups of water included). 

Adult acne is most often associated with stress and hormonal imbalance, but how can you tell the difference? "Acne caused by stress or hormones can look very similar, but a good way to tell them apart is when the breakout is happening," Goldfaden says. 

First off, hormonal breakouts occur seven to 10 days before your menstrual cycle begins, he notes. If you're not in this time frame, then it may be caused by stress—or another factor listed in the next section.