By Markham Heid
November 8, 2017
TIME Health
For more, visit TIME Health.

Few things can wreck a person’s confidence like a big old pimple. It would be cruelly ironic if stressful situations — a wedding, say, or a public speaking engagement — could trigger a breakout. Unfortunately, experts say the associations between stress and acne are now well-established.

“When we went into our study, we were uncertain of the results — we thought we might debunk some myths,” says Dr. Alexa Kimball, a professor of dermatology at Beth Israel Deaconess Medical Center. She’s referring to a study she and colleagues conducted back in 2003, when the links between stress and acne were still largely anecdotal. But Kimball’s research on university students found stress could indeed trigger an acne episode. And the greater the stress, the more pronounced the breakout.

Since then, many follow-up studies have helped elucidate the relationship between stress hormones and zits. While stress alone isn’t the cause of acne pimples — age, hormones, acne-producing bacteria and other factors are at play — it’s evident that stress can trigger breakouts and make existing acne issues worse.

“We know there are several things going on here,” says Dr. Adam Friedman, an associate professor of dermatology at George Washington University. He points to a stress-related hormone called CRH, or corticotrophin-releasing hormone, as one culprit. CRH can bind to receptors in the skin’s sebaceous glands, and that binding drives up the skin’s oil production — which can cause pimples.

“These sebaceous glands are also immune organs, and they can create inflammation,” Friedman adds. “At the end of the day, an acne blemish is basically inappropriate inflammation, and so turning on that immune response can exacerbate swelling or redness.”

Even more bad news: “We know that when people are stressed, there’s an increase in nerve signaling that causes itch,” he says. “That can cause people to scratch or pick at their skin, which can create even more swelling and redness.”

Apart from these biological drivers of stress-related acne, Kimball says feeling frazzled can also cause people to sleep poorly, consume less-healthy foods, and break away from their usual skin-care routines — all of which could further promote acne breakouts.

So far, all of these issues have to do with short-term or “acute” stress. But chronic stress could also affect the duration and resolution of acne breakouts. There’s some evidence that chronic stress can affect the immune system in ways that slow healing, Friedman says. If you’re dealing with all-the-time stress, your acne breakouts may stick around longer, and could be more likely to result in scarring, he says.

As if all this weren’t bad enough, there’s research that acne is on the rise among women.

“We do see more acne in adult women than we’ve ever seen before, and there are theories that stress could be an influence,” Kimball says. A 2014 study in Archives of Dermatological Research, titled “Could adult female acne be associated with modern life?”, speculated that urban noise and rising socioeconomic pressures might be a factor in the uptick in adult female acne.

What can a person do to prevent stress-related acne breakouts? Practicing proven stress-reduction techniques is a good start.

Mindfulness meditation and exercise are two research-backed stress-killers. So are tai chi and yoga. When you’re at work, organizing your spaces — both real and virtual — and cutting out your incessant email-checking habit can also help knock down stress. Kimball also recommends sticking to your typical eating, sleep, and skin-care regimens.

Finally, if you can spot a stressful event on your horizon, ask your doctor for help. “They might be able to prescribe some more aggressive topical treatments or oral antibiotics, or other things that may help,” Kimball says. “All of our treatments are better at preventing acne than treating it, so if you know you have a wedding or something stressful coming up, let your dermatologist know.”

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