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Stress and Acne

Dermatologist, Psychologist Talks About The Link Between Stress and Acne

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Updated April 14, 2013

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Is there a connection between stress and acne breakouts? Is it just your imagination, or does your acne really get worse when you're under a lot of stress? What's really going on with your skin when you're stressing out?

I interviewed a doctor who is both a board-certified dermatologist and clinical psychologist to get the skinny on the link between stress and acne. Richard Fried, M.D., Ph.D., weighs in on the effects stress has on our skin and, more specifically, stress and acne.

How does stress affect the skin?

Dr. Fried: We've now come so much further in our understanding of so-called nerves of the skin. We know that there are these nerve endings in the skin -- many, many nerve endings in the skin that release these chemicals called neuropeptides.

Neuropeptides are basically stress-induced chemicals that create inflammation in the skin. That can show itself as redness. It can show itself as bumpiness and changes in sensation, itch, burn, tingle, pain, sensitivity. Neuropeptides are absolutely, intimately related to stress.

We know that other aspects of the immune system in the skin are altered by stress. Our ability to fight infection in the skin is diminished under stress.

There's a fascinating article published in the Archives of Dermatology that shows that stress directly impairs our ability to fight cancer formation. We use a model to test the most opportunistic of cancer forming aspects of medicines called the "nude mouse model."

They're called "nude" because they're actually missing one or two aspects of the immune system, and they're a perfect model to use because we know -- due to their deficiency -- [that] they form cancer rather quickly.

So we can test a given cream, lotion; we can test other medicines in the skin to see whether that baseline cancer formation time resulted. In the nude mouse model, we expose them to ultraviolet radiation.

It's 21 days, on average, before they get their first skin cancer. And that's been replicated over and over. If you put a mouse under stress, that 21 days has dropped to 8 days before baseline, their first tumor.

How do you know when a mouse is stressed? And this is not a joke. The natural predator of the mouse is the fox. So the smell of fox urine stresses mice dramatically. We can measure that by their heart rate, [and] their respiratory rate.

What role does stress play in acne development?

Dr. Fried: Stress, in my estimation and based on most of the studies, is a log on the fire if you will. It is a worsening factor for acne.

If you take a pie chart and cut it into many slices, each of the slices representing one of the things that can contribute to the formation of acne or the worsening of acne, we know that stress is one of the slices of the pie.

Hormones, another slice. Genetic predisposition, another slice. Lifestyle in terms of diet, lifestyle in terms of exercise. Occupation -- are you exposed to things that worsen or unmask acne?

If you add to that pregnancy. If you add to that mechanical factors like hairstyles and pomade acne.

Now, how many of those factors have to be in place before either we start breaking out or our breakouts get worse? For any given person, it's probably different.

For some people the threshold to make acne may be so low, by genetic endowment, that any of the factors will make them break out and the removal of any of those one factors will make them better. For other people, it may be you may have to have two, three, four. You got to have the hormones, you got to have the stress, you have to have the poor diet.

So, what we can say about stress is the studies show that statistically, under stress, if you are acne prone you will break out more, you will break out more severely, and your acne will take longer to improve.

Can relieving stress improve acne breakouts? Is stress reduction alone enough to clear a case of acne?

Dr. Fried: Embracing a legitimate stress management technique -- be it yoga, tai chi, progressive muscle relaxation, hypnosis, one of the guided imagery relaxation programs like one that I made for improving acne [CD: Freedom from Acne, Living Better in Better Skin] -- any of those statistically will make us break out less often, make our pimples less severe in terms of the redness and of the size and the intensity, and make you more responsive to conventional treatments.

No, I don't think stress management alone is sufficient for most people. But there's another component of the benefits of stress management even if stress management alone doesn't, in quotes, "fix" the acne enough.

When we're under less stress we tend to be more focused, we tend to take better care of ourselves, we tend to have more energy. So we are more likely to use the acne preparation that we may have gotten over-the-counter or by prescription, remove makeup at bedtime, wash our faces.

You know, one of the arguments that I've heard over the years [is], "Are you sure it's stress management and psychodermatology that makes people's skin do better, or isn't it maybe the fact that they just feel better so they take better care of themselves and use their medicines?"

Now, my answer to that question is, the data shows it's more than just the self care and the medicine use. The data shows we really do modify physiology.

But to tell you the truth, I'll be OK with the fact if it is nothing more than people feeling better, feeling happier, and taking better care of themselves. Because we know stress management may make people live longer. We know stress management makes people enjoy life more.

Next: Acne's Emotional Toll

Read the entire interview with Dr. Richard Fried:

Part 1: The Mind-Skin Connection

Part 2: The Stress Connection

Part 3: The Emotional Impact of Acne

Part 4: Why We Pop Pimples

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