Stress Acne: What Causes It and How It Differs From Other Acne

Most of us have experienced a breakout or two at least once in our life. Acne, as we know, doesn't discriminate and getting blemishes is a normal part of life. But sometimes there's a spot that pops up right before a special event or a few stubborn spots that keep reappearing in one particular area of your face. And you can't help but wonder what the cause is. Well, it could be your period but it could also be stress. Yes, stress can cause wrinkles, hair loss and you guessed it, acne.

Some of you have probably heard of hormonal acne, but might be confused on what stress acne is. Luckily we spoke to four skincare experts to breakdown the difference between stress acne and hormonal acne.

What Is Stress Acne?

"In times of stress, your stress hormones rise and trigger your oil glands to produce more oil, which then triggers acne flares,” Dr. Hart explains. Hormones also play a similar role, but according to Dr. Hart, the difference is timing.

If you find you mostly get breakouts around your period, you are likely experiencing hormonal acne rather than stress acne. "Hormonal changes, mainly increased androgen levels, have the same effects on oil glands,” Dr. Hart says. "The main way to tell the difference is to track acne triggers, for example, after a period of stress versus more regularly with monthly menstrual cycles."

If you're still a bit confused about stress acne, hormonal acne and other forms of acne, Yoon helps us break it down even further. "Stress acne is technically a form of hormonal acne where stress can trigger a hormonal response that precipitates things like higher oil production, which can lead to acne. And the phrase "hormonal acne" is more commonly understood as acne triggered by hormonal fluctuations caused by things like menstrual cycles, pregnancy, menopause, PCOS, or a specific hormonal pattern your body has. Bacterial acne is an inflammatory response to bacterial overgrowth or imbalance. Fungal acne is technically not acne, but follicles that become clogged or infected with an overgrowth of yeast. Acne mechanica is acne caused by friction or pressure on the skin."

The location of stress acne may vary. If you find you’re normally breaking out in the same place around the same time of the month (e.g., your chin or jawline), you can bet that your acne is likely related to your menstrual cycle rather than your stress levels. This is especially true if the acne takes on the form of painful cysts. According to Dr. Green, these "usually appear in the same spot over and over again and become severely chronic because they’ve accumulated so much oil over days or even weeks."

"Breakouts worsened or caused by stress typically appear in the oiliest parts of the face like the T-zone," Dr. Mack says. "Stress triggers elevated cortisol levels that increase oil production resulting in clogged pores and worsening breakouts."

Dr. Green adds that stress acne is often accompanied by telltale signs like redness and itchiness.

Causes & Prevention of Stress Acne

First things first: What causes stress acne? Stress, of course, but it's a little bit deeper than that. According to a 2017 research review in The Journal of Clinical and Aesthetic Dermatology, "a self-administered, dermatologist-validated questionnaire of 3,305 women ages 25 to 40 years in France" revealed adult-onset acne was reported by 41 percent of the women, and that "stress was listed as a precipitating factor for acne in half of the women surveyed."

So, how does stress actually relate to the cause of blemishes on your face? That’s where things get a little more complicated. Stress comes with an increase in cortisol, and increases in cortisol trigger a systemic response within the body that has the potential to impact the immune system, digestive system, reproductive system, and growth processes. Cortisol is key in causing stress acne breakouts as well, with the upped cortisol being associated with a rise in sebum (or oil) production. More oil production means more clogged pores, and more clogged pores mean more breakouts.

Considering the involvement of cortisol, when we talk about stress acne, we’re talking about hormonal acne in a way as well. It’s not the same as acne that will show up around the start of your menstrual cycle, but it is acne that’s appearing because of a response to an alteration of your regularly scheduled hormonal pattern. "When you’re under an increased amount of stress, this can trigger hormonal changes that simply worsen your acne," Dr. Green explains. "Stress acne can happen at any time, at any age. Usually, in adults it’s because they’re stressed at work or at home, in younger adults, it’s mostly because of school."

Treatment of Stress Acne

For treatment options, Dr Green recommends “a topical spot treatment, something like salicylic acid, which can be found over-the-counter.” We like Murad's Rapid Relief Acne Spot Treatment ($26) to help shrink blemishes, reduce the appearance of redness, and to soothe skin.

Dr. Mack says that treatment depends on the type of stress breakout. "If you have stress breakouts that are most consistent with comedones, i.e whiteheads and blackheads, look for products that promote cellular turnover and reduce oil production like salicylic acid or vitamin A derivatives like a retinoid or retinol," she explains. "If the stress breakout is cystic meaning that the lesion is red, inflamed and under the skin, consider seeing a board-certified dermatologist for a dilute cortisone injection to reduce tenderness, redness and elevation. If you do not have access to dermatological care, apply a warm compress to the area. This will help to reduce tenderness."

Yoon recommends using the Peach Slices Acne Spot Dots ($5) as it prevents popping and picking, and also helps flatten blemishes overnight.

“If stress acne seems to happen often, then try switching your skincare routine. Find products that work with your skin, not against it,” Dr. Green recommends.

If you suspect that your acne may be due to stress or hormonal-related reasons, talk to your dermatologist about your immediate skin care options to help speed up your recovery.  

Find Ways to Manage Your Stress

Since stress is the cause of stress acne, finding ways to manage your stress can also help cure it.

Dr. Mack says it might be good to consider holistic options like cortisol supplements. "These products have become very popular and contain ashwagandha, an adaptogen. Ashwagandha has been shown to improve sleep, promote a sense of calm, improve mood, focus and sleep. Moreover, it can help the body adapt to and recover from chronic stress."

"Beyond products, the best approach is to destress, which can be easier said than done," Yoon says. "Some helpful de-stressing tools include meditation, positive self-talk, going for walks, acupuncture, magnesium, stress balls, aromatherapy, or bonding with pets, but the key is to find what works for you—and to be kind to yourself and not stress about being stressed."