Last Updated on September 20th, 2019
The biggest cause of acne is stress1. Skin breaks out in times of emotional stress, but the skin has it own special sensitivities to stress that you can totally prevent.
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Everybody who has acne knows that acne causes stress. But medical scientists have also demonstrated that stress causes acne2.
Dermatologists at Stanford University recruited students who came into the university clinic for acne treatment for two skin exams, one during a relatively stress-free time, and one during exam week. The skin science researchers also gave the students questionnaires designed to measure stress. The results showed, as the researchers wrote in their article in the Archives of Dermatology, “Changes in acne severity correlate highly with increasing stress”3.
Why does stress cause acne breakouts? Part of the answer seems to be that the brain and the skin4 both make the same stress-related hormone that causes inflammation. Another part of the answer seems to be that stress interferes with the thyroid’s response to thyroid stimulating hormone, and low levels of thyroid hormone leave the skin more vulnerable to inflammation. Vitamin A and medications like Retin-A raise thyroid hormone levels when they heal the skin. And yet another piece of the puzzle seems to be that stress increases production of not just testosterone but also two other sex-related hormones, luteinizing hormone and prolactin. When these hormone levels normalize, the skin clears up.
But you really don’t have to be an expert in endocrinology to make commonsense use of the knowledge that stress causes acne5. This simple fact means that people with acne who know they are about to undergo a period of high stress need to be especially diligent about doing their daily skin care routine and taking any prescription acne medication. It also means that doctors need to take stress into consideration when they prescribe medication for acne. Even if you cannot stop stress, you can plan for stress, and do everything you need to do for the health of your skin. But sometimes acne is triggered by stress that is localized in the skin.
People who have oily skin tend to get whiteheads that just won’t go away and blackheads the size of traffic lights. These acne blemishes form in response to stress, but not the kind of stress that comes with finals in college or pledging a fraternity6.
Pores in oily skin tend to clog with a combination of dead skin cells and sebum. Even though oily skin by definition makes an unusually large amount of sebaceous oil, the oil usually can flow to the surface because pores are larger, too. The problem comes when both dead skin and oil have to flow through the pore. This can be too much for the pore. The oil and dead skin harden and form a persistent whitehead that can become a prominent blackhead.
What kills oily skin? Sunburn, for starters. People who have oily skin often have darker skin that usually does not burn—so they do not use sunscreen. Unusually hot and bright sun, however, or exposure to the sun after using benzoyl peroxide, Accutane, Retin-A, Tazorac, or Differin, however, can make the skin peel. Tiny bits of dead skin get stuck in pores and clogs result.
The second most common cause of acne on oily skin is using the wrong acne care products. Alcohol dries out the skin. Big bubbles of detergent cleanser can dry out the skin. Some essential oils heal dry skin, but other essential oils, particularly menthol, actually can kill the uppermost level of the skin. Anything that leaves the skin feeling tingly is killing cells in the epidermis which can subsequently clog oily skin.
One of the most important principles of preventing blemishes on oily skin is gentle cleansing. Oily skin repairs inflammation by producing even more oil7. As long as you can keep up with oil production and dead skin, it will stay clear. But clearing up acne on oily skin is a lot easier if you do not add the stress of detergent cleansers, menthol, and alcohol-based skin care products.
People who have dry skin tend to get pimples, lots and lots of tiny, red pimples. Dry skin breaks out8 it is exposed to irritant chemicals that sensitize the pores to inflammation generated by the immune system9.
The pores in dry skin tend to be smaller because they produce less oil. There is less room for the pore to conduct dead skin, excess oil, and acne bacteria to the surface, and the walls of the pore are in closer contact with the tiny blood vessels that bring nutrients and oxygen to the skin and connect the skin to the immune system.
The tiny red pimples that are characteristic of dry skin are not actually caused by acne bacteria. They are caused by the skin’s release of histamine10 after it is “excited” by contact with irritant chemicals. The reddening of the skin that is concentrated in pimples is the skin’s way of isolating an irritant that finds it way into the pore.
Unfortunately, this also traps bacteria inside the pore along with skin oils. But the immediate cause of most pimples on dry skin is some kind of irritant chemical. This can be alcohol in an acne care product. It takes 46% alcohol to kill acne bacteria on contact, but this amount of alcohol also causes skin irritation. Lower amounts of alcohol not only do not kill acne bacteria, they trap bacteria inside pores by irritating the skin.
Some essential oils irritate dry skin, especially mint, peppermint, menthol, and wintergreen. Some botanicals irritate skin, including all of the botanical ingredients in Noxzema, camphor, menthol, and eucalyptus, as well as cinnamon, citrus, lemon oil, and linalool in other products. Disinfectant chemicals can irritate dry skin. The stress of irritation makes dry skin break out, usually after use of the wrong acne treatment products.
There is a long list of safe and unsafe products for treating acne-prone skin11. You can check your product choices against cosmetic safety guides or the articles on this site one by one. Or you can invest in a safe acne treatment system that takes the stress out of acne treatment with simple, inexpensive products that work, such as Exposed Skin Care.
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