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How Acne Makes Your Skin Stress Out

Everybody who has acne knows that acne is worse when you are under stress. Stress makes acne worse1, and as soon as you look in the mirror or you hear that first snide remark, acne makes stress worse. There is a vicious cycle between stress and acne that keeps the condition flaring up again and again even if you take good care of your skin. And there is a growing body of scientific evidence that acne bacteria take advantage of stress to protect themselves from the immune system.

Everyone, whether they have acne or not, has a few acne bacteria in their pores. In small numbers, acne bacteria are actually useful. They keep excessive amounts of sebum from building up.

Stress and Acne
Stress produces hormones in your body which can make acne worse.

The inflammation that causes pimples is not the fault of acne bacteria. It is well known to dermatological science that the redness, itchiness, and swelling in pimples is actually caused by the immune system’s misguided attack2 on the skin itself rather than on the bacteria. But why should our immune systems, which are so good at getting rid of most kinds of disease-causing bacteria, aim at healthy tissues when they are confronted by acne bacteria?

The answer seems to be a unique relationship among acne inflammation, acne bacteria, and stress. And there are similar processes at work in sagging skin, wrinkled skin, dandruff, seborrhea, and subcutaneous (under the skin) weight gain.

Stress Hormones In Your Skin

When your brain senses stress, the a gland inside the brain known as the hypothalamus secretes a substance called corticotrophin-releasing hormone3 (abbreviated CRH). This hormone travels through the bloodstream to the adrenal glands, where it triggers the release of the stress hormone cortisol. This is the hormone that raises your blood sugar levels and your blood pressure and clears your bloodstream of fatty acids by parking them inside your fat cells.

When your skin senses stress, it doesn’t have to wait on the brain to send a signal to your adrenal glands to release stress hormones. The skin makes its own CRH to respond to its own stresses.

How does the skin respond to stress? When the skin is cut or broken or burned, or infected, or exposed to toxic chemicals, CRH:

  • Stimulates the oil glands to make more sebum4. The added skin oil makes the skin more flexible—or wrinkled, depending on how long stimulation goes on.
  • Stimulates the keratinocytes to release inflammatory chemicals. These leukotrienes can attack infectious microorganisms. They can also attack healthy skin cells.
  • Stimulates a process known as ductal hyperkeratosis. This term just refers to thickening the lining of pores so toxins can’t come in and blood and body fluids won’t leak out.

Thickening the walls of pores, however, traps oil and bacteria inside. The oil that is trapped in the pore is food for acne bacteria, which multiply rapidly. The skin senses the infection and releases histamine5, the same chemical that causes allergic reactions, to attack the bacteria.

Acne bacteria, however, have a way of defending themselves. They can release compounds called chemotactins that redirect inflammation to the lining of the pore itself. This gives them a path to escape to the surface of the skin where they may be brushed or washed into another nearby pore that is not affected by stress.

The action of breaking down the pore wall that was made thicker by stress generates still more stress. Other pores undergo the process of ductal hyperkeratosis, accumulate acne bacteria and skin oil, and form new pimples. On and on the process goes until:

  • The skin is calmed. This can happen by a lowering of stress6 in the rest of the body and/or with the help of certain antioxidant minerals, such as selenium.
  • The bacteria are killed. The immune system, however, can react even to dead bacteria, so inflammation continues even after acne bacteria are wiped out by antibiotics or antiseptics, at least for a few days to a few weeks. Or,
  • The immune system is “toned down” so it does not a lot of stress to deal with the problems caused by a dysfunctional response to a little stress.

But what can calm down the skin?

Zinc As Acne Fighter

It turns out that a great way to calm down an overactive immune system in the skin is to supply the skin with zinc. Zinc oxide, zinc acetate, and zinc gluconate have all been used with good results in acne care, although zinc oxide tends to leave a white tint on the skin that doesn’t look good on dark skin. (On black skin, zinc oxide leaves a kind of purple cast.)

Zinc doesn’t stimulate the immune system. Zinc regulates7 the immune system. In acne, at the surface level, inhibiting the immune system—which doesn’t succeed in killing acne bacteria anyway—is a good thing.

It only takes a very small amount of zinc to have a large effect on the skin. Skin creams that contain as little as 0.06% zinc have been found to help control pimples. But testing at the Institute de Recherche Pierre Fabre in Toulouse in France has also found that zinc can help control blackheads and whiteheads.

Acne bacteria, it turns out, has the capacity to release chemicals that lock onto genes in specialized skin cells known as keratinocytes. The task of keratinocytes is to make still more skin cells. They sometimes create a thin, transparent layer of skin that both locks sebum and bacteria inside a pore and protects the bacteria (but not the skin itself) from toxins and injury.

That is what happens when skin grows over a pimple, a blackhead, or a whitehead, so that you are tempted to squeeze or pick at your pimple to open it up. (But don’t do that. That’s the role of8 alpha- and beta-hydroxy acids.)

Acne skin care products that contain zinc can circumvent this process. Many of the creams that contain zinc, such as Almay Clear Complexion Makeup, Almay Nearly Naked Foundation, Artistry by Amway Mineral Foundation, Biotherm Biosource Softening Lotion for Dry Skin, CeraVe Facial Moisturizing Lotion, Eucerin Everyday Protection, Murad Clean Scene, Paula’s Choice Skin Recovery, and Cellex C Body Smoothing Lotion, all products we don’t usually associate with acne skin care, actually have the ability to help prevent pimples, blackheads, and whiteheads.


  1. Jović A., Marinović B., Kostović K., Čeović R., Basta-Juzbašić A., Bukvić Mokos Z. The Impact of Pyschological Stress on Acne. Acta dermatovenerologica Croatica. 2017;25(2):1133-141.
  2. Antiga E., Verdelli A., Bonciani D., Bonciolini V., Caproni M., Fabbri P. Acne: a new model of immune-mediated chronic inflammatory skin disease. Giornale italiano di dermatologia e venereologia. 2015;150(2):247-54.
  3. Kono M., Nagata H., Umemura S., Kawana S., Osamura R.Y. In situ expression of corticotropin-releasing hormone (CRH) and proopiomelanocortin (POMC) genes in human skin. FASEB Journal. 2001;15(12):2297-9.
  4. Zari S., Alrahmani D. The association between stress and acne among female medical students in Jeddah, Saudi Arabia. Clinical, Cosmetic, and Investigational Dermatology. 2017;10:503-506.
  5. Elenkov I.J., Webster E.L., Torpy D.J., Chrousos G.P. Stress, corticotropin-releasing hormone, glucocorticoids, and the immune/inflammatory response: acute and chronic effects. Annals of the New York Academy of Sciences. 1999;876:1-11.
  6. Chen Y., Lyga J. Brain-Skin Connection: Stress, Inflammation and Skin Aging. Inflammation and Allergy Drug Targets. 2014;13(3):177-90.
  7. Maywald M., Wessels I., Rink L. Zinc Signals and Immunity. International Journal of Molecular Sciences. 2013.
  8. Okano Y., Abe Y., Masaki H., Santhanam U., Ichihashi M., Funasaka Y. Biological effects of glycolic acid on dermal matrix metabolism mediated by dermal fibroblasts and epidermal keratinocytes. Experimental Dermatology. 2003;12Suppl2:57-63.
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Anonymous Reply

I just want to say THANK YOU! I have dealt with acne forever. I'm in my 40's and this is the best explanation for why I flare up like a pizza with double pepperoni everytime life throws extra stress my way. Zinc. So easy. I just ordered some zinc cream and crossing my fingers. I'm thanking you in advance -- this article gives me hope.

February 23, 2017 at 11:39 pm Reply

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