There might be a reason why your breakouts seem to happen at the worst times.

By Colleen Murphy
March 03, 2021
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You have a presentation that you've been working on for weeks. Days before the big day, you realize you have more pimples popping up than usual. But while it might seem the universe has it out for you, there could be a simpler explanation: stress acne.

Generally, stress acne is a flare or worsening of preexisting acne in response to a psychological stressor, Allison K. Truong, MD, fellow of the American Academy of Dermatology (AAD) and dermatologist at Cedars-Sinai Medical Group and Cedars-Sinai Medical Center in California, tells Health. For instance, if someone normally only has one or two pimples, they might suddenly—thanks to stress—have 10, 20, or 30 pimples. And all the things they used to do to keep their acne at bay are no longer helping. (So yes, even people who have been able to successfully manage their hormonal acne using hormonal birth control can experience an outbreak brought on by stress.)

Here's everything you need to know about stress acne, including who can most likely expect to get it, where it will typically pops up, and what you can do to treat it.

What causes stress acne?

Well, yes, stress. It's been long established by researchers, like those from a study published nearly two decades ago in JAMA Dermatology, that there is a connection between increased stress and increased acne severity. But why does stress cause acne to flare or worsen? It's an answer that researchers are still trying to pin down.

There are a variety of factors that might have an effect, but an increase in specific hormones is one of the most widely agreed upon causes. The Cleveland Clinic reports that one of those hormones is cortisol—the "fight-or-flight" hormone. Other hormones that 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 shows up for people who have 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. 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," she explains. "And that's when we start to really dive into, what is new, what has changed. And usually, it's been a stressful trigger."

A few years ago, a team of researchers from Croatia analyzed different acne studies. Doing that, they found that emotional stress makes acne worse for between 50% and 80% of people.

Angela Lamb, MD, associate professor of dermatology with the Icahn School of Medicine at Mount Sinai in New York, also says that people who have more acne-prone skin, such as those who have 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 can't 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 tells Health.

Where on your body does stress acne pop up?

Typically, acne that's been brought on by stress develops in the same areas you usually get (or used to get) acne, Dr. Truong says. So if your acne during a non-stressful time shows up on your forehead, then you can expect your stress acne to pop up on your forehead too. Other common places stress acne appears is along the jawline and chin. Although less common, it can also develop on the chest and back.

But going back to the jawline and chin: This past year, Dr. Lamb has seen an increase in breakouts in those areas due to the "maskne," which is acne caused by facial irritation from wearing a face mask. "[Maskne] follows the pattern of stress-induced acne. So is [your acne] from the mask or is that from the stress? That begs the question," she says.

How long does stress acne take to develop and go away?

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 says it might be more difficult 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, she estimates that the acne could take about four to six weeks to clear up.

What type of stress causes it?

Whether it's acute or chronic stress that brings on acne depends on the person. While one person might have an acute stressor that triggers a flare up of acne, another person may be chronically stressed and unable to control all the intermittent flare ups that they have.

Sometimes, people are stressed and don't even realize it. Maybe they're able to manage the stress day-to-day, or maybe 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.' And I'm like, 'That sounds pretty stressful.' And then they're like, 'Yeah, OK, it's been pretty hard lately,'" Dr. Truong says.

On top of the emotional stress, Dr. Lamb also likes to ask her patients about other types of stress, including dehydration or lack of sleep, which itself can be due to stress.

So how do you know if it's stress acne or something else?

So yes, stress acne is something that you're normally not having and then, all of a sudden, you are. But just because you were (or are) stressed, and now have new red bumps on your face, chest, or back, it 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, it could be folliculitis (a bacterial or fungal infection of the hair follicles), or allergic contact dermatitis (a rash from an allergy, maybe in response to a skin care 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 doctor just to make sure it is what you think it is because if you're treating it with the wrong thing, you could potentially make it worse," Dr. Truong says.

How do you treat stress acne—and can you prevent it?

Recognizing that the acne might be stress-related is probably the most important—and hardest—step in managing stress acne, Dr. Truong says. The first step to getting rid of the acne, of course, is to try to destress. Dr. Truong suggests trying stress-relieving techniques, such as meditating, journaling, or doing yoga. With the absence of the 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," Dr. Truong says.

Different products can help clear up stress acne, too. First, Dr. Truong recommends to always start with a gentle cleanser like a Cetaphil foaming cleanser ($15.88 for a pack of two, amazon.com), morning and night. Aside from that, though, treatment varies person-to-person. For instance, for someone with mild acne who is already using a gentle cleanser and wants something a little stronger, a cleanser that includes benzoyl peroxide, salicylic acid, or glycolic acid, such as Neutrogena Rapid Clear Stubborn Acne Cleanser ($7.99, amazon.com) or CeraVe Acne Foaming Cream Cleanser ($11.97, amazon.com), may help, she says.

Or, if a patient with mild acne is already using a topical, gentle cleanser in combination with a topical antibiotic regimen, such as topical azelaic acid, dapsone, or clindamycin, Dr. Truong might then consider adding on a low topical retinoid, such as an over-the-counter adapalene gel, like Differin ($12.88, amazon.com), or a prescription tretinoin cream.

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

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,' so something like an oral antibiotic regimen, such as doxycycline or a minocycline, just to try to get them better quickly, and then slowly taper them off of this regimen."

Regardless of which products are used to manage the acne, Dr. Truong says that "the most important thing is you have to treat the cause, and that would be treat the stress—if there is a way that we could do that."

And overall, the best way to prevent stress acne is to prevent the stress that's causing it. Obviously, stress is often unavoidable, but there are things you can to do help relieve your stress. As Health previously reported, this can include spending time in nature, doing light exercises, setting work-life boundaries, and cleaning up your space. Also important 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.

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