Friday, March 7, 2014

Acne and Stress: the Research

Anecdotally, you've probably heard of the cycle: "You get stressed; you break out from stress; you get more stressed because now you're breaking out." But what's the science say about the link between stress and acne?

Even before specific research examined this topic, there was reason to suspect that acne may be caused or exacerbated by stress. Firstly, stressful life events are associated with the onset of other skin disorders, such as psoriasis. Furthermore, it's been found that 50% of acne patients who seek dermatological help report that stress exacerbates their acne.

Image Source: http://www.flickr.com/photos/21484712@N00/2739337639/in/photolist-5b4PDi-jhXoU1-7V9K4L-jhVD48-jhZYpf-jhZMHA-jhZYiU-4dtg1j-jisBPJ-jisCvU-jhVMdK-dLEWKG-5zoes5-MXiJc-86pj7E-qEGQX-deeEXW-5xh7vL-6iS8us-5t7AUu-jhZEd2-67D1Xk-chr9Hh-a8CA7A-5xkGw4-5KATgZ-92Uywz-92Uxnz-92Uy1g-jhXf1Z-ea2qnU-e9VKg8-ea2qv9-e9VKke-e9VKP2-ea16SU-e9UqRp-ea2qyE-e9UqE6-e9VKn6-ea16Ub-ea2q2C-ea2q6o-ea17bw-ea16Nj-e9Ur3n-e9UqUt-ea2qwU-e9UqMv-e9VKhK-e9VKzF

In the past decade-and-change, a couple of studies have tackled this subject more head-on. A 2003 study in the Archives of Dermatology by Chiu, Chon, and Kimball tracked 22 acne-suffering college students. Any current or former students will probably be unsurprised to hear that both stress levels and acne levels substantially increased during midterms and finals. Another study, in 2007, looked at acne in high-stress (during midterms) and low-stress (during a break from school) conditions for adolescents. They found a weak positive correlation (r=0.23) between self-reported stress levels and acne severity.

The link is definitely real, but what's actually causing the problem? Unfortunately, the mechanism isn't really clear. The aforementioned 2003 study controlled for changes in sleep hours, sleep quality, diet quality, and number of meals per day, but still found that stress levels predicted pizza faces. In other words, taking care of yourself while you put up with stress isn't enough-- if stress is causing your acne, you need to de-stress, too. The authors of the 2007 study had hypothesized that increased stress caused increased sebum production, which led to zit city. However, they found that there was no difference between the participants' sebum levels in high stress conditions. Something else is at play.

"Cracking Under Stress"
Image Source: http://www.flickr.com/photos/44124366475@N01/6273248505/in/photolist-aym3dZ-8tofTB-9BMsED-rnkhi-cEJPoW-eeJkVy-vJRJo-vJRJk-e9T2AS-egdAKf-egdAKS-8rCEY4-8rCEWV-8rCEZZ-8rFKPb-6u3YB-8rFKPY-aoZjw3-7h6PeD-es178Y-dSdeDk-6PhcBT-dFcBts-hu1WqH-ff8yW-3B7c9-9v6Xcb-ff8GC-4miyxd-4miv2o-4meskH-4mixV1-4miycY-4mev8H-4mes3p-dydhXf-b4riTB-coQ7t3-5JE8Vi-efSKUD-86AtMA-cwDpgy-p2eG2-auQjsU-auQjtm-auQjsf-9jctx9-93R2VM-afDxkr-55AMbS-sZDh8

There are a few plausible explanations. Stress increases production of a steroid hormone called cortisol. Neurological disorders associated with high cortisol, such as insomnia, are also associated with acne. Thus, it's possible that cortisol levels are part of the fundamental cause. Additionally, psychosocial stress (such as a job interview) and stress as a result of sleep deprivation can can disrupt skin barrier function. It seems plausible, then, that this skin barrier disruption might lead to colonization by some yucky strains of P. acnes, the bacteria most strongly associated with pimples. Given that the body's healing process is slowed by stress, it's also possible that acne heals more slowly when you are stressed the fuck out. Sadly, this is hypothetical as fuck. Until more research is done, the connection between stress and zits is going to remain hazy.

Luckily, the information we do have (stress-->acne) is something we can actually work with. For an estimated one third of individuals with skin disorders, we know that emotional and psychological factors need to be addressed in order to efficaciously manage the problem. According to Yadav and colleagues (2013), antidepressants such as SSRIs and anti-anxiety medications such as benzodiazepines can help resolve some skin conditions. Additionally, they report that other psychological treatments, such as cognitive behavioral therapy or placebo medication can result in tangible benefits to one's skin.

Although it's difficult to determine whether your acne in particular is exacerbated by stress (unless you take very careful records...), anyone facing significant stress (acne or no!) should consider working to reduce their psychological stress level. My totally non-ground-breaking, easier-said-than-done tips:

  • Get a good night's sleep whenever possible. 
  • Try to manage your workload to put less pressure on yourself at critical times. 
  • Try to work in moderate exercise into your week. 
  • Eat healthily. 
  • Take time to do things you love. 
  • I am just not a meditator, but if you are: meditation has been pretty effectively demonstrated to have beneficial skin effects in a variety of studies (most dealing with psoriasis, not acne). If meditation works as a de-stressor for you, it might be a good practice to include in your daily routine. 
  • If you're suffering from chronic stress, talk to your doctor about seeing a psychologist or counselor. Don't worry about just your skin; your wellbeing is important as hell! Take care of yourself!

8 comments:

  1. Stress totally screwed up my skin by causing a hormonal imbalance. I had low progesterone, and estrogen dominance, and what came with that was the worst jawline and cheek acne of my life. I also had the bonus of being on my period or something that resembled a period for the better part of each month. Even with taking micronized progesterone, it took several months to get back on track. I think there are many ways stress can make acne worse, and there's another one.

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    1. Oh no! That sounds so frustrating. I'm glad you're getting back on track, though.

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  2. hmmm, my skin has been better for the past couple of years now that I've been in therapy and taking an SSRI. Then again, I was finishing up my Accutane course when I started those things.

    On a completely unrelated note, I signed up for Hautelook for the express purpose of getting a deal on theBalm products, and it didn't take long for them to appear. You rave about theBalm products so often, and since you have such high standards, I'm willing to take the plunge and order something I haven't seen in person. I placed an order this morning. Two eyeshadow palettes and a concealer are coming my way!

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    1. Oh fun! I hope you like them! I made a Hautelook order from that sale as well! Looking forward to trying Cindy Lou Manizer.

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  3. Robyn, what shade of Tarte foundation do you use? Are you still wearing it? What is it about the formula that you feel covers acne so well? What about the Balm Time Balm Concealer? Does it budge? (I was just reading your blog about covering acne.)

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    1. I wear Tarte Ivory in the summer, but it's too dark right now. I think the texture is what helps you build it up to cover, although there are thin formulas with great coverage as well.

      In theBalm, I wear Lighter than Light and have never had any migration problems.

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  4. Right before my wedding (which coincided with the last chance I was going to have to take data for my PhD before the lab that I built FROM SCRATCH was going to be deconstructed), my stress levels were at an all-time high. Consequently, I started to suffer from huge pimples on my neck just under my chin (jut what you want right before your wedding). My skin has always been pretty good, actually, so this was unprecedented. Now that the wedding stress is behind me, and the lab is set up afresh, although my thesis is due in 3 months (= yeah, still stressful!), that bout of acne has subsided almost back to how my neck used to be. Whatever the cause actually is, there's definitely a correlation for me!

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    1. Ouch! I'm glad you're almost out of the woods!

      I have never noticed a huge correlation between acne and stress, but I get serious physical symptoms of stress, most notably in the form of body parts swelling to way bigger than they should be... :(

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