Stress and Spots - What's the Relationship?

Medical Reviewer

Does this sound familiar? "I know exactly what will happen, I'll wake up on the morning of the interview/my date/my audition with a huge red spot on my nose." For some people their skin seems to act as a barometer of how they feel inside. Sometimes of course the predictions of hair loss, baldness, rashes or spots simply don't come to fruition, but sometimes they seem to. So does stress cause spots or not?

The first thing we've all probably noticed is that some people can be under enormous levels of stress yet nothing, not even a tiny pimple, blemishes their otherwise perfect skin. Others have very different experiences. Another thing is that plenty of middle-aged and older adults still get spots, so the idea that spots are a curse reserved teens is simply wrong. It's self evident that spots and various skin conditions affect some people and not others. This points to the fact that some people are, for whatever reason, predisposed. So what do we know?

When people are under stress they release more of the stress hormone cortisol. This has the effect of increasing oil production in the body and that can result in a bout of acne, even in adults who may never have experienced it before. According to the American Academy of Dermatology stress makes the skin more sensitive and more reactive. Stress, they say, makes psoriasis or rosacea worse and acne becomes more inflamed and persistent. Brittle and ridged nails are also signs of stress as are hives, excessive perspiration and hair loss. The Academy also points out that skin neglect sometimes comes with stress, so scratching, rubbing, pulling and picking act to increase problems that already exist.

But that still doesn't tell us whether stress actually causes acne. When Dr. Alexa Kimball from Stanford University followed 22 students with acne through their exams, she found that acne worsened as self-reported levels of stress increased. Dr. Kimball also accounted for their sleep patterns, diet, and number of meals in a day, but the most she could conclude was that increasing stress exacerbates acne. A point of interest here is the fact that many people have suggested that stress and acne have something of a circular relationship. That is, stress makes or causes spots and acne worse, which results in more stress, which makes the skin worse still. During Dr. Kimball's study she noted that high achieving populations tend to be less concerned about their appearance during examinations, so perhaps this casts a shade of doubt over the vicious circle theory?

Apart from cortisol, spots are thought to result from other hormones such as testosterone, which is most apparent in teenagers. It is estimated that around 80 percent of adult acne occurs in women around the time of their period, pregnancy or as a result of polycystic ovary syndrome. Steroid medications and lithium, used in the treatment of certain mood disorders can also result in acne.

Acne myths include dirty skin, poor hygiene, sexual activity and chocolate. Although there is some debate about the role of certain diets most experts do not subscribe to the idea that diet has a role in acne.

As things stand it seems that stress may not, of itself, be a cause of spots or acne but it does seem to have a role in making things worse. Clinical psychologist and dermatologist Richard G. Fried, MD says when dermatologists treat both the skin and stress, the skin often clears more quickly as the influence of stress is diminished.

The message seems to be that stress reduction techniques such as relaxation, yoga or meditation, coupled with exercise and a balanced lifestyle will all help to reduce the effects of stress, which in those vulnerable to spots, may help to reduce its worse effects and make the duration of outbreaks shorter.


American Academy of Dermatology

BBC News: