Why Is My Acne So Bad? How Stress Exacerbates Skin Conditions

Plus how to manage multiple skin conditions at home.

April 30, 2020 — 4 p.m. EST

I’ve had a problem with acne for 14 years now. While I’ve learned how to get it under control with trial and error skincare regimens, I’m not immune to the occasional flare-up. Since I’ve been quarantined, my skin has gotten worse. I have acne everywhere: on my face, behind my ears, on my back and chest, even on my scalp. Why is my acne so bad? I can’t help but blame it on unprecedented stress caused by this pandemic. To try and get to the bottom of my issue, I spoke to Rachel Pritzker, MD of Chicago Dermatology, and ALASTIN Skincare partner for answers.

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Dr. Pritzker says stress can cause your skin to react in a negative way. “There are many skin conditions that we see directly worsen during times of stress. I would say the top diagnoses that worsen with stress in the skin are rosacea, acne, eczema, seborrheic dermatitis, and hair loss (telogen effluvium, in particular),” says Dr. Pritzker. But how do you fix it? Especially now, when things like stress management or actually seeing a dermatologist might be difficult to do.

Before treatments and solutions can be offered, it’s important to understand exactly how stress plays a role in exacerbating skin conditions. When you’re stressed, your body’s response to protect you is to release more hormones, like cortisol and adrenaline. These hormones affect people differently, but when it comes to your skin several reactions can happen. When cortisol is released, “[it can cause] pro-inflammatory cytokines, which makes the skin sensitive and ready to attack any possible trigger. Signs of an ongoing attack [if the stress isn’t letting up] can [signal] a rosacea flare, seborrheic dermatitis rash on face or scalp, or eczema.” Additionally, when your cortisol production increases, “there is a signal [from the brain] to produce more oil from the sebaceous glands, and therefore more acne breakouts occur,” says Dr. Pritzker. While it may seem like you can’t stop your body’s stress response, there are certain things you can do to manage your symptoms and improve your skin right now at home.

How to Treat Skin Conditions At-Home

“To treat various conditions at home during times of stress, I usually recommend being as simple and anti-inflammatory in your routine as possible,” says Dr. Pritzker. This means keeping your routine the same and not introducing new products that could potentially make your skin worse.

If eczema is your main concern, Dr. Pritzker recommends using a moisturizer that is specifically for dry, itchy, eczema-prone skin. It’s best to apply it as soon as you get out of the shower and make sure you rinse with lukewarm water so your skin doesn’t get agitated. Additionally, “[don’t use] too much soap in areas that don’t need it [as this can] strip the skin.”

To treat rosacea Dr. Pritzker recommends focusing on decreasing inflammation in the skin with anti-inflammatory topical treatments like cream and moisturizers. If you don’t know which would be best for your skin, consult your dermatologist. “Avoid triggers like alcohol, spicy foods, and coffee which can flush your face making it feel hot and inflamed,” she adds.

For seborrheic dermatitis on the scalp, Dr. Pritzker says a simple solution is adding anti-dandruff shampoo to your shower regimen. If you find the problem isn’t on your scalp but rather red and scaly skin on your face (between eyebrows, around nose, and close to your hairline) you should try a nourishing moisturizer; “It is also recommended to not over exfoliate, this is not just dry skin, [this condition] needs to be treated like a rash.”

For dry skin, it’s not only important to moisturize, but you should also make an effort to control the air around you. “Use a humidifier in your bedroom, as staying inside more than usual makes your skin dry out due to the lack of humidity inside air can have,” says Dr. Pritzker.

If acne is your problem area, remember not to try and treat it with a bunch of new products “which can strip the skin” rather than helping it, advises Dr. Pritzker. If you don’t already use a retinol or a spot treatment with sulfur (which helps remove dead skin), you may want to call and ask your dermatologist for recommendations. Otherwise, continue your normal skincare routine that has worked in the past and avoid picking at your face.

My Problem Is With Hair Loss Specifically

“With hair loss, the key is to stop the shedding cycle,” says Dr. Pritzker. There are ways to do this naturally by helping yourself de-stress through meditation, good sleep, exercise, and anything else that calms your mind and eases your anxiety. In more extreme cases, consider consulting with an expert via telemedicine for an oral supplement.

How Do I Stop the Cycle of Stress?

Unfortunately, having a skin issue that worsens under stressful conditions can just cause more stress. In my case, developing acne under stress causes me to look in the mirror and get more stressed out because of the way my skin looks. “It is quite a vicious cycle,” says Dr. Pritzker. “To break the cycle takes awareness.” Even if it’s hard, you need to maintain a healthy lifestyle to counteract the stress. This means getting good sleep, exercising, eating healthy foods, and building a routine again; “[all these things] can help our hormone system to relax.”

You also need to stop picking your skin. No matter what your skin condition is, picking at it will not make it better. “I am a picker too, but that will lead to longer lasting scars that will remind us of these stressful times and it is not worth it,” cautions Dr. Pritzker.

What Should I Do If It’s Not Getting Better?

If your condition is severe and nothing you try seems to be working, you should reach out to a professional. Dr. Pritzker says there might be a reason for your worsening condition, like an infection, that needs to be checked out. Many dermatologists are available to consult via telemedicine. Call your dermatologist to see if they offer this option, or do some research online to find one that’s best for you.

“[All of this is] easier said than done, but don’t take this time to obsess over your skin,” advises Dr. Pritzker. “Don’t stress about the little fluctuations and actually take this time to pare down on your routine to provide the least inflammatory conditions for your skin. A good antioxidant product, moisturizer, and several hours of sleep can really turn [things] around.”


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