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.
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.
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!