Acne appears most often in times of stress; see how to treat

It all starts in the womb.

A mass of cells divides and develops, separates and stretches, and from a single layer of embryonic tissue two seemingly separate but inherently connected systems are born: the brain and the skin.

They are linked for life. When one feels shame, the other blushes. When one feels pain, the other processes it. And when one bears the brunt of a pandemic, political unrest, structural racism and the increasingly serious consequences of climate change… well, a pimple appears on the other.

​Or maybe, depending on the person’s genetic predispositions, it’s not a pimple, but an eczema flare-up. A psoriasis crisis. An acne breakout. A dehydrated, dull, oily or even –sigh– older appearance. A nuisance, if you will.

This is your skin under stress.

“There are two different types of stress: acute and chronic,” said Dr. Whitney Bowe, dermatologist and author of “The Beauty of Dirty Skin”. A quick bout of stress can be a good thing. It can enhance your senses, improve mental clarity, and help create collagen to facilitate wound repair. He arrives and leaves.

It is chronic, ongoing stress, the kind that every sentient being is likely to experience today, that affects the skin.

It affects the entire being, of course, and a compromised skin is the least of its consequences. But “the skin is the organ we see,” said Loretta Ciraldo, dermatologist and founder of the Dr. Loretta.

And in a society where unsustainable stress is not just the norm but sometimes a welcome sign of success, what better way for the subconscious to scream than “stressed skin”? (After all, it’s easier to ignore your feelings than your face.)

How stress affects the skin

Much of the skin-psyche connection comes down to the overproduction of cortisol, the main stress hormone, and its effect on the skin barrier.

“The barrier retains moisture and keeps allergens, irritants and pollutants out,” Bowe said. It effectively does the job of most skin care products on the market without products, and it needs three things to work: oil, water, and the microbiome. Cortisol depletes them all.

During times of stress, cortisol slows down the production of beneficial oils. “We become dry, rough and much more irritated because these healthy oils act as a protective layer for us,” said Ciraldo. Without adequate lipids to seal in moisture, the skin begins to “leak” water in a process known as transepidermal water loss (TEWL).

At the same time, cortisol stimulates the overproduction of sebum, the oil that is involved in acne. “So for a lot of people, skin looks oilier when they’re under stress, and it’s more prone to acne,” she said.

All of this alters the skin’s pH, which compromises the acid mantle and creates an inhospitable environment for the 1 trillion symbiotic microorganisms that exist in the skin’s barrier – also known as the microbiome.

Under ideal conditions, the microbiome makes topical skin care almost superfluous.

There are microbes that feed on sebum, which helps maintain healthy oil levels. There are microbes that feed on dead skin cells – the original exfoliants! There are microbes that produce peptides and ceramides, two beauty ingredients that keep skin firm and hydrated. There are even those that offer protection from pollution, sunlight and invading pathogens.

“If you’re not producing enough of these healthy fats and you’re not maintaining a healthy barrier, you’re going to alter the terrain where these microbes grow and thrive,” Bowe said. “Imagine getting all the nutrients out of the soil and seeing if your garden will grow. It’s the same for your skin.”

In turn, the microbiome can experience an overgrowth of so-called bad bacteria (such as C. acnes, the strain associated with acne) and a dearth of good bacteria. The microbiome becomes more prone to infection, irritation, inflammation and hyperpigmentation. It becomes more sensitive to external aggressors such as free radicals generated by pollution.

Stress also causes the body to produce internal free radicals. “You can think of free radicals as little missiles,” Bowe said, as they target cells for destruction and cause oxidative stress.

When free radicals reach DNA, they lead to skin cancer. When free radicals target elastin and collagen, they lead to fine lines and wrinkles. When free radicals target lipids, they lead to dehydration and skin barrier damage and acne.

Chronic exposure to cortisol also inhibits the production of hyaluronic acid and collagen. “That’s what keeps skin looking fresh and youthful,” Bowe said. “When you can’t produce enough, the skin gets thinner.”

Unfortunately, hyaluronic acid serums and collagen creams cannot neutralize cortisol. Topical ingredients do not serve the same biological purpose as those produced in the body, and they rarely penetrate the lower layer of the dermis, where collagen and hyaluronic acid naturally reside.
In fact, skin care products are not the answer to stressed skin.

“Most of the products are aimed at consumers who have a healthy skin barrier,” said Ron Robinson, cosmetic chemist and founder of BeautyStat Cosmetics. Exposing an already broken barrier to active ingredients – or an excess of ingredients – only exacerbates existing problems.

Therefore, Ciraldo recommends removing ingredients that degrade the barrier, such as glycolic acid, salicylic acid, benzoyl peroxide and retinol, from your stressed skin routine. “They’re very drying and really deplete normal, healthy barrier function,” she said.

Treat stress to heal your skin

Managing stress can seem almost impossible, considering that many modern stressors are systemic. However, according to dermatologist Heather Woolery-Lloyd, “90% of our stress is not the stressor itself, but how we deal with that stressor.”

In other words: while meditation cannot mitigate global warming, it can at the very least clear your skin.

Meditating, Woolery-Lloyd said, initiates “the relaxation response,” which activates the body’s parasympathetic nervous system and lowers cortisol and inflammation. With consistent practice, the skin’s barrier can stop leaking and begin to lock in moisture, suggesting that the legendary inner glow is more scientific than symbolic.

Ciraldo tells his patients to think of meditation as “The Transforming Magic of Organization” for the mind.

“Try to find a place where you can sit quietly for 20 minutes a day and really review your thoughts as if it were your closet,” she said. “If something comes to your mind that doesn’t give you joy, apply energy to dismissing that thought.”

Don’t like meditation? It doesn’t matter. Breathing, which can trump water intake as the simplest – but undeniably effective – skin care tip, is enough.

Research by Dr Herbert Benson of Harvard Medical School shows that breathing slowly and deeply triggers the relaxation response and, according to Bowe, “can prevent psychological stress from being translated into physical inflammation in the skin.” Breathing classes, such as those offered at the ALTYR Holistic Healing Center, can help with the technique.

To treat and prevent free radical damage, fill your plate with antioxidants, which stabilize these unstable molecules and leave skin clearer, calmer, brighter and more even. Vitamins A and C (abundant in fruits and vegetables), lycopene (found in tomatoes), astaxanthin (salmon) and polyphenols (green tea, dark chocolate) are all great options, according to Bowe.

Exercise also increases antioxidants. (You see, the body produces yet another popular skin care ingredient on its own.) It lowers cortisol levels, which means fewer breakouts and a stronger skin barrier. What if you exercise outdoors? Even better.

“I’m a big believer in the healing power of nature,” Woolery-Lloyd said. “People say, ‘I don’t have time,’ but it doesn’t have to be a time-consuming thing. Just going out and seeing a tree, watching some birds, has been proven to reduce inflammatory markers in our body.”
If all else fails, cry.

“Crying relieves stress and helps lower cortisol levels,” said Dr. Purvisha Patel, dermatologist and founder of Visha Skincare. “This can result in fewer crises.” She notes that orgasms have a similar effect on cortisol (and are, by all accounts, more pleasurable).

“That’s not silly,” said Ciraldo. “These are things we can do for our skin and for ourselves that don’t cost anything, but the payoff is great.”

Translated by Luiz Roberto M. Gonçalves