While previously only examined as a causal relationship, new research suggests that acne and stress have a bidirectional association.
Even though emotional stress has long been put into the relationship with acne, its influence has been mostly underestimated. But in working with acne patients on a daily basis, I have seen that stress is a very important trigger and exacerbating factor in acne.
In a study done in the University of Zagreb School of Medicine in Croatia of 111 patients with adult acne that 56% implicated stress as an exacerbating factor and cited lifestyle changes (hostile work or school environment, moving, and traveling) among the most stressful events. Beyond stress, other factors that contributed to the severity of acne included having sensitive skin, discontinuing oral contraceptives, and using cosmetic foundation. Most troubling was that 82% of patients reported 3 or more stressors that aggravated their acne.
Even when hormonal factors may trigger acne in adulthood, stress is still implicated in its severity and exacerbations. Such was the case according to a study by Di Landro and colleagues that examined associations between acne and health and lifestyle choices in 518 women age ≥25. Women who had acne that had persisted since adolescence tended to have the following characteristics: first-degree relatives with acne; no previous pregnancies; little intake of fruit, vegetables, or fresh fish; psychological stress; and current office work. The team also reported that the higher the stress levels, the greater the likelihood of acne.
Raising awareness of the skin-psychological connection will hopefully go a long way toward helping patients and improving overall outcomes.
Knowing that there is a bidirectional intimate relationship between the skin and the mind, hopefully clinicians will approach their patients in a more holistic and interdisciplinary way[s] that involve[s] not only dermatologists but also psychologists and psychiatrists. We must minimize our stress as much as possible, rest more, participate in sports/physical activities, meditate, and stay positive.
