A monster of a cystic pimple appearing on your cheek just in time for your big presentation. A new breakout arriving in the middle of an already-bad week. The bride who wakes up to a smattering of zits in anticipation of her wedding. If you’ve ever experienced the uncanny arrival or intensification of acne during a stressful period, it’s not just you — and it’s no coincidence, either. Stress really can contribute to acne, rosacea, and even skin aging, and it’s all due to cortisol, commonly referred to as the stress hormone. However, stress isn’t always bad for skin, and you can absolutely harness it to keep your complexion within your control. We tapped a handful of board-certified dermatologists to break down this complicated topic.
What Is Cortisol?
When you’re sleep-deprived, worn out from exhaustion, or just generally stressed, your adrenal glands (the small glands that sit on top of your kidneys that produce hormones) release a surge of a hormone called cortisol. Essentially, cortisol is your internal alarm system, and notifies the rest of your body when you’re under stress. This gives you a surge of energy and enables your body to function. This hormone is essential to survival — so much so that nearly every cell in the body has cortisol receptors, says Zena Gabriel, MD, a board-certified dermatologist based in Newport Beach, California. “Cortisol can have many different physiologic actions, depending on which sort of cells it is acting upon,” she explains. “It’s involved in blood sugar regulation, metabolism, memory formation, cognitive function, the inflammatory process, and it influences blood pressure, too.”
How Too Much Cortisol Can Affect Skin
A host of problems can arise when cortisol levels are constantly elevated from various forms of stress. We don’t only mean mental and emotional sources, like the last-minute cancellation of a babysitter, but physical and environmental stress — such as consistent poor sleep — as well. “This [causes] harmful effects in the immune system, cardiovascular disease, blood vessel damage, skin conditions, and mood disorders,” warns Melissa Levin, MD, a board-certified dermatologist in New York City. New evidence also shows that, like your adrenal glands, skin cells can also produce cortisol, which can slow wound healing and increase inflammation.
Cortisol instigates skin issues in a few other ways, too. The first is by reducing your skin’s immunity. Small bursts of stress can actually help boost your skin’s immunity by limiting inflammation; but when the body is frequently flooded with cortisol, its lymphocytes — the white blood cells that fight infection — are decreased. The fewer lymphocytes you have, the less likely your body (and skin!) can battle harmful bacteria.
And, as we know, bacteria — specifically P.Acnes — causes acne. “[Cortisol] decreases the immune function of the skin, compromising the skin's ability to ward off the bacteria known to worsen acne,” Dr. Gabriel explains. That P. Acnes bacteria can then have a free-for-all in your pores, causing or exacerbating breakouts.
On top of that, cortisol creates a domino effect within your system by increasing your body’s amount of androgens. This is a group of hormones (including testosterone) that can cause hormonal acne, particularly in adult women. “Androgen increases oil production, as well as increasing degradation of important proteins in your skin, like collagen and elastin,” says Dr. Levin. “It can also change how your blood vessels respond, which has a huge role in skin aging and other inflammatory conditions, especially rosacea.” Essentially, consistently high levels of cortisol — and stress — can have a deleterious effect on your skin’s health.
How to Address Your Stress-Induced Acne
Unfortunately, there’s no way to treat cortisol topically, though Dermalogica® Phyto-Nature™ Firming Serum ($145) gets close. It has biomimetic peptides (meaning they mimic skin’s natural functions) to reinforce skin’s defenses. Babor® Stress Control Ampoule Serum Concentrates ($40) also works to help soothe skin with wild indigo extract, reducing redness and inflammation.
[Editor’s note: As always, talk to your doctor before starting or stopping any new treatment.]
Beyond attempting to control cortisol itself, work on tackling cortisol’s effects. First, address an overload of bacteria with topical treatments or antibiotics (as prescribed by your doctor), such as benzoyl peroxide or clindamycin. You can also treat the excess oil production caused by androgens with retinol, which reduces excess sebum. “Retinols and vitamin A-derivative creams can reduce the oil at the surface and improve acne overall,” says Dr. Gabriel. Try Glow Recipe® Avocado Melt® Retinol Sleeping Mask ($49), which has encapsulated retinol and nourishing avocado oil to minimize any irritation.
[Editor's note: Retinol shouldn't be used by those who are pregnant, considering getting pregnant, or nursing. Please consult with your doctor before use.]
Lastly, do whatever helps you unwind. Reducing stress may reduce cortisol, and thus minimize the effect of stress on the body. “Meditation, exercise, reading a book, going on a walk, or anything that can decrease stress can [help] impact skin issues like acne or psoriasis,” suggests Dr. Levin. “The skin responds to emotional stimuli and psychological influences.” (Worth noting: An active sex life can work wonders.)
While stress reduction can be “a powerful antidote to all stress-related skin disorders,” as Dr. Gabriel puts it, it’s not going to cure acne on its own. Yes, cortisol could be triggering your acne, but your diet, skin type, and even sleep could also be to blame. “A multi-pronged approach is the best method to relieve acne papules and the entire process,” she says. Just make sure that a part of that approach is reducing stress, especially if you’re feeling more frazzled, tired, or anxious than usual. Your skin may not just look better — you might feel better, too.
Dr. Melissa Levin is a paid Allergan® consultant.
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