What Is Stress Acne—And How Do You Get Rid of It?

You have a presentation that you've been working on for weeks. Days before the big day, you realize you have more pimples than usual. But while it might seem the universe has it out for you, there could be a more straightforward explanation: Stress acne. Here's everything you need to know about stress acne—including who is most likely to get it, where it will typically pop up, and what you can do to treat it.

What Is Stress Acne?

Generally, stress acne is a flare or worsening of preexisting acne in response to a psychological stressor, Allison K. Truong, MD, an American Academy of Dermatology (AAD) fellow and dermatologist at Cedars-Sinai Medical Center in Los Angeles, told Health.

For instance, if someone typically only has one or two pimples, they might suddenly—thanks, stress—have 10, 20, or 30 pimples. And they may notice that all the things they used to do to keep their acne at bay are no longer helping. So, even people who have successfully managed their hormonal acne using hormonal birth control can experience an outbreak brought on by stress.

Causes

The culprit of stress acne? Well, yes, it's stress. 

A study published in Clinical, Cosmetic, and Investigational Dermatology showed a correlation between stress and acne severity. But why does stress cause acne to flare or worsen? Some researchers have proposed a few theories.

For example, an increase in specific hormones is one of the most widely agreed upon causes. The 2017 study stated that one of those hormones is cortisol—the "fight-or-flight" hormone. Other hormones our bodies increase production of in response to stress are androgens.

"These hormones stimulate the oil glands and hair follicles in the skin, which can lead to acne," according to the AAD. "This explains why acne can be an ongoing problem when we find ourselves under constant stress."

Who Gets Stress Acne?

According to Dr. Truong, stress acne more commonly appears in people with a history or current diagnosis of acne.

"Usually, it's people who have had acne some time in their life as a teenager or maybe hormonal acne [...], but then they've been pretty well-controlled and maintained on certain acne regimens or acne therapies," Dr. Truong explained. "And then, all of a sudden, they have a flare-up or worsening of their acne for whatever reason. And it doesn't really make sense to them." 

"And that's when we start to really dive into, what is new, what has changed. And usually, it's been a stressful trigger," Dr. Truong added.

One review published in Acta Dermatovenerologica Croatica, which analyzed several acne studies, found that emotional stress worsens acne for 50% to 80% of people.

Angela Lamb, MD, associate professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York, added that people with more acne-prone skin, such as those with larger pores or tend to have more oily skin, are a bit more sensitive to stress acne.

But that's not to say that people with historically clear skin cannot also get stress acne. 

"I have people who've never experienced acne before. And then all of a sudden, in their 30s, 40s, and 50s—with the different stressors of life, whether it's dealing with children or elderly family members—they start to get stress acne," Dr. Lamb told Health.

Location of Breakouts

Typically, acne that's been brought on by stress develops in the same areas you usually get (or used to get) acne, explained Dr. Truong. So, if your acne during a non-stressful time shows up on your forehead, then you can also expect your stress acne to pop up on your forehead. 

Other common places stress acne appears includes along the jawline and chin. Specifically, during the COVID-19 pandemic, Dr. Lamb saw an increase in breakouts in those areas due to "maskne," acne caused by irritation from wearing a face mask. 

"[Mask-ne] follows the pattern of stress-induced acne. So, is [your acne] from the mask, or is that from the stress? That begs the question," noted Dr. Lamb.

And although less common, stress acne can also develop on the chest and back.

Duration of Stress Acne

Stress acne can develop in anticipation of a known stressor and then become more severe as you are experiencing the stressor itself. Or, the breakout could come days, weeks, or even months after the stressor.

If you're under chronic stress, Dr. Lamb said it might be more challenging to get the acne under control because of the frequent flare-ups that happen over time. 

But if the breakout is from more of an acute stressor, like the death or illness of a family member, Dr. Lamb estimated that the acne could take about four to six weeks to clear up.

Acute vs. Chronic

Whether it's acute or chronic stress that brings on acne depends on the person. One person might have an acute stressor that triggers a flare-up of acne. In contrast, another person may be chronically stressed and unable to control all their intermittent bursts.

Sometimes, people are stressed and don't even realize it. Maybe they're able to manage the stress daily, or they've developed coping mechanisms to make themselves feel as though they aren't stressed.

"But if you delve into it and ask, a lot of my moms are like, 'Well, I've been taking care of my two kids and having a full-time job at home,'" recalled Dr. Truong. "And I'm like, 'That sounds pretty stressful.' And then they're like, 'Yeah, OK, it's been pretty hard lately.'"

On top of the emotional stress, Dr. Lamb said she also likes to ask her patients about other types of stress, including dehydration or lack of sleep.

Differentiating the Cause

You don't typically have stress acne, and suddenly, you do. But just because you were (or are) stressed and now have new red bumps on your face, chest, or back doesn't necessarily mean you have stress acne.

According to Dr. Truong, a sudden breakout could also be due to an infection or rash. For instance, your acne may be due to folliculitis or allergic contact dermatitis. Folliculitis is a bacterial or fungal infection of the hair follicles. And allergic contact dermatitis is a rash from an allergy, maybe in response to a skincare product.

"If something is new for you, it's not common, and it's worsening, I think that's an important time to visit your [healthcare provider] just to make sure it is what you think it is," said Dr. Tuong. "Because if you're treating it with the wrong thing, you could potentially make it worse."

Treatment

Recognizing that the acne might be stress-related is probably the most important—and most challenging—step in managing stress acne, explained Dr. Truong.

The first step to getting rid of the acne, of course, is to try to destress. Dr. Truong suggested trying stress-relieving techniques, such as meditating, journaling, or doing yoga. Without stress, the acne will eventually go away on its own.

"It may take a few days, weeks, months. Usually, I tell people, however long it took to get there is however long it will resolve on its own," noted Dr. Truong.

Different products can help clear up stress acne, too. First, Dr. Truong recommended always starting with a gentle cleanser, like Cetaphil Oil Free Gentle Foaming Cleanser, every morning and night.

Aside from that, though, treatment varies person-to-person. For instance, someone with mild acne who wants something a little stronger may try some of the following cleansers:

• Benzoyl peroxide, like CeraVe Acne Foaming Cream Cleanser
• Salicylic acid, like Neutrogena Rapid Clear Stubborn Acne Cleanser
• Glycolic acid, like L'Oreal Paris Skincare Revitalift Derm Intensives Gel Cleanser 

Or, a person with mild acne may be using a gentle cleanser in combination with a topical antibiotic regimen, such as topical azelaic acid, dapsone, or clindamycin. In that case, Dr. Truong recommended adding a low topical retinoid, such as an over-the-counter (OTC) adapalene gel (like Differin) or a prescription tretinoin cream.

"If these things don't help, then I would highly recommend getting prescription medications from your dermatologist," said Dr. Truong.

The treatment approach could also depend on how quickly someone wants their acne to clear up.

"If somebody is like, 'Oh my gosh, I can't work like this'—even though [their acne is] mild to me, but they're telling me it's affecting their quality of life—then I would jump to a quicker 'improvement,'" Dr. Truong noted. "So, something like an oral antibiotic regimen, such as doxycycline or minocycline, just to try to get them better quickly, and then slowly taper them off of this regimen."

Regardless of what products you use to manage acne, Dr. Truong said that "the most important thing is you have to treat the cause. And that would be treating the stress—if there is a way that we could do that."

A Quick Review

The best way to prevent stress acne is to avoid the stress that's causing it. Obviously, some types of stress are often unavoidable. But there are things you can do to help relieve your stress.

Try enjoying nature, doing light exercises, setting work-life boundaries, and cleaning your space. Also essential to keep in mind: Try not to stress even more over your stress acne. It may take a while, but it will go away eventually.