In this world, nothing is certain but death and taxes… and breakouts. We’ve all dealt with a blemish at least once in our lives, and I would bet my life savings that the majority of adults reading this article will experience at least one more before the month is over. They can suck, but they’re just a normal part of having skin—which, you know, is something you generally want to have, particularly on your face. But, as an adult, there are times when acne breakouts can indicate a bigger issue, past the general explanation of clogged pores. Things like stress and hormones can cause acne breakouts—and if you’re suffering from repeated breakouts, this may be the explanation for why.
"In times of stress, your stress hormones rise and trigger your oil glands to produce more oil, which then triggers acne flares,” Donna Hart, M.D., FAAD, a board-certified dermatologist at Westlake Dermatology in Austin, Texas, explains.
Meet the Expert
Donna Hart, MD, is a medical, surgical, and cosmetic dermatologist. Hart is published in several medical journals, is board-certified by the American Board of Dermatology, and is a member of the American Academy of Dermatology, American Society for Dermatologic Surgery, and Women’s Dermatologic Society.
Hormones also play a similar role, but according to Hart, the difference is timing. If you find you mostly get breakouts around your period, it’s likely your acne is related to hormones rather than stress. "Hormonal changes, mainly increased androgen levels, have the same affects on oil glands,” Hart says. "The main way to tell the difference is to track acne triggers, for example, after a period of stress versus more regularly with monthly menstrual cycles."
What Causes Stress Acne
First things first: What causes stress acne? Stress, of course, but it's a little bit deeper than that. According to a 2017 research review in The Journal of Clinical and Aesthetic Dermatology titled Emerging Issues in Adult Female Acne, a self-administered, dermatologist-validated questionnaire of 3305 women ages 25 to 40 years in France, researchers found "adult onset acne was reported by 41 percent of women," and, "stress was listed as a precipitating factor for acne in half of the women surveyed."
So, how does stress actually relate to the cause of blemishes on your face? That’s where things get a little more complicated. "Emotional stress triggers an increased release of the stress hormone cortisol," Sonia Vaidian, M.D. of EHE Health, explains. According to the Mayo Clinic, when increased, cortisol triggers a systemic response within the body that has the potential to "alter immune system responses and [suppress] the digestive system, the reproductive system and growth processes."
Cortisol is key in causing stress acne breakouts as well. According to Vaidian, "When cortisol levels rise, they disrupt levels of hormones that regulate sebum balance and result in clogged pores and development of acne.” In other words: More oil production means more clogged pores, and more clogged pores mean more breakouts.
Considering the involvement of cortisol, when we talk about stress acne, we’re actually talking about hormonal acne in a way as well. It’s not the same as acne that will show up around the start of your menstrual cycle, but it is acne that’s appearing because of a response to an alteration of your regularly scheduled hormonal pattern. "When you’re under an increased amount of stress, this can trigger hormonal changes that simply worsen your acne," Michele Green, M.D., a New York City-based board-certified dermatologist explains. "Stress acne can happen at any time, at any age. Usually in adults it’s because they’re stressed at work or at home, in younger adults it’s mostly because of school."
Meet the Expert
Dr. Michele S. Green is a board-certified dermatologist with an MD from Mount Sinai Medical School in NYC. Green worked for global skin care brands, L'Oréal, Johnson and Johnson, Bioré, and RoC on the research, development, and safety testing of worldwide product launches. She has published articles in professional journals including The Journal of American Academy of Dermatology and Cosmetic Dermatology.
Where Stress Acne Is Located
This can vary. If you find you’re normally breaking out in the same place around the same time of month—i.e., your chin or jawline—you can bet that your acne is likely related to your menstrual cycle rather than your stress levels. This is especially true if the acne takes on the form of painful cysts: According to Dr. Green, these "usually appear in the same spot over and over again and become severely chronic because they’ve accumulated so much oil over a span of days or even weeks."
But stress acne, as opposed to other types of breakouts, will usually appear in the oiliest areas of your face. "[Stress] pimples or acne lesions typically appear on the T-zone," Dr. Vaidian shares. “When this is the case, the acne is usually accompanied by dilated pores, shininess, blackheads, whiteheads, and uneven or grainy skin.” Regular acne, on the other hand, will not appear with these accompanying symptoms. Similarly, Dr. Green says that stress acne is often accompanied by telltale signs like redness and itchiness."
What To Do About Stress Acne
“If you work with your skin, the results will be there one step at a time,” Dr. Green says. For treatment options, she recommends “a topical spot treatment, something like salicylic acid which can be found over-the-counter.” If it’s something deeper—a stress “cyst,” something under-the-skin, perhaps—"just hold a warm or cold compress over the affected area to decrease the pain and/or redness.” This should be done for a few minutes twice a day until the spot is minimized.
“If stress acne seems to happen often, then try switching your skincare routine. Find products that work with your skin, not against it,” Dr. Green recommends. Dr. Vaidian also suggests taking care to ensure your stress levels are managed as well. “Drink plenty of fluids, eat a healthy diet and do things to manage your stress such as get more sleep and do things to relax,” she says.
If you suspect that your acne may be due to stress or hormonal-related reasons, talk to your dermatologist about your immediate skincare options to help speed up your recovery.
Melibary YT, Alkeraye S, Alnutaifi KA, Melibary NT, Alsuwaidi MK, Algzlan HI. Occasional acne; an acne variant. Clin Cosmet Investig Dermatol. 2019;12:219‐222. doi:10.2147/CCID.S199991
Elsaie ML. Hormonal treatment of acne vulgaris: an update. Clin Cosmet Investig Dermatol. 2016;9:241‐248. doi:10.2147/CCID.S114830
Zeichner JA, Baldwin HE, Cook-Bolden FE, Eichenfield LF, Fallon-Friedlander S, Rodriguez DA. Emerging issues in adult female acne. J Clin Aesthet Dermatol. 2017;10(1):37‐46.