Does stress cause acne? Science says so.
Stress is one of the leading causes of inflammation and acne is no exception, but how in the world does stress affect our skin? Science can explain.
Two ways that stress can cause acne:
a leaky gut; and
a surge in hormones.
Let’s begin with the gut.
First, it’s important to understand a bit of basic information about the intestinal wall. Our intestines are lined with epithelial cells that are joined together by something called the junctional complex, also known as “tight junctions”.
diagram created in BioRender.com
Why are these tight junctions important?
They act as guardians between the intestinal lining and our bloodstream. Their job is to keep out foreign substances, undigested food proteins, and microorganisms that don’t belong in our blood.
What do tight junctions have to do with stress?
When under stress, our body’s sympathetic nervous system releases norepinephrine, a stress hormone, in the gut. From there, it’s a cascading sequence of events that ultimately activates myosin light chain kinase (MLCK), an enzyme important in the contraction of smooth muscle. This causes the epithelial cells in the intestinal lining to contract. In turn, the tight junctions relax, thereby creating a gap between the epithelial cells which allows foreign debris to get into the bloodstream (de Punder and Pruimboom, 2015).
What happens next?
Immune cells detect that there’s an invader in the bloodstream and release cytokines (group of proteins) in response. These cytokines further activate the MLCK enzyme causing the epithelial cells to contract again and so the cycle continues allowing more foreign matter to enter the bloodstream. This is how chronic stress leads to chronic inflammation of the gut - those tight junctions between epithelial cells remain relaxed allowing foreign substances to continuously get into the bloodstream.
diagram created in BioRender.com
But, how do cytokines affect acne?
There are different types of cytokines released by our immune cells, but the ones that are of particular interest when it comes to acne are known as interleukins. Interleukins are responsible for regulating cell growth and stimulate immune responses, like inflammation. Interleukins can be proinflammatory or anti-inflammatory. IL-8 (Interleukin-8) is a proinflammatory interleukin with proliferation properties that is more prominent in the skin of people who have acne (Tanghetti, 2013). The proliferation properties of IL-8 could explain the higher than normal skin cell turnover rate that people with acne are dealing with.
What does this mean?
Put simply, if IL-8 is released during stress and it is also found in the skin of people with acne, then this may explain the link between stress and acne.
In summary, stress causes the epithelial cells in our gut lining to contract, thereby relaxing the tight junctions which allows foreign debris to enter the bloodstream. In response, our immune system releases cytokines like IL-8, which may contribute to the formation of acne.
Now that we’ve covered the stress-gut-acne connection, let’s take a closer look at another way stress can cause acne - by a surge in hormones.
How does a stress-induced surge in hormones lead to acne?
When we are under stress, our adrenal glands release the primary stress hormone, cortisol. In the short term, cortisol acts as an anti-inflammatory and uses glucose stores for energy (Hannibal and Bishop, 2014). Cortisol signals the liver to flood the blood with glucose and ushers it to our muscles where it will be used as energy in “fight or flight” mode. Cortisol also counteracts the blood glucose lowering effects of insulin (USCF, 2020). If it didn’t, insulin would store the extra glucose, but we need it temporarily for energy to “get away from danger”. While this is beneficial in short term stressful situations, it’s harmful under chronic conditions. It means that our blood sugar levels are chronically high because insulin isn’t able to store the extra glucose.
How do high blood sugar levels affect acne?
Insulin has an inverse relationship with SHBG (sex hormone binding globulin). Studies suggest that high levels of insulin are correlated to low levels of SHBG (Wallace et al, 2013). SHBG is responsible for regulating the levels of sex hormones like estrogen and androgens in the body and has a particular affinity for testosterone.
If the levels of SHBG are low then they are not able to rid the body of testosterone which could lead to hyperandrogenism - an excessive amount of androgens, like testosterone, circulating the female body. This can lead to the development of acne.
So, what can we do about it?
If you are like everyone else on this planet living a modern life with a career, family responsibilities, technologies, school, and relationships, then you will deal with stress at some point in your life. The key to relieving your stress depends on two factors:
Self-awareness. Being present and aware of your feelings so you can recognize your stress in the moment; and
Implementing effective stress management techniques that work for you, both in the short term and the long term.
SHORT TERM STRESS
Recognizing your stress in that moment and then implementing a stress management technique will help calm your nerves. Someone cuts you off when driving - this is an example of short term stress.
One of my favourite techniques to use in moments like this is called the “S” Technique. Breathe in slowly through your nose, inhale deeply and fully. Allow your belly to expand as you inhale. You may find it helpful to put your hand on your belly so you can ensure your belly is rising and falling as you breathe in and out. On the exhale, try making an “s” sound, like the sound of a snake hissing; this slows down your exhale and in turn calms your nervous system. Exhale all the way through your mouth until you are out of air. Allow your belly to fall completely. Repeat this several times until you feel your body begin to relax.
LONG TERM OR CHRONIC STRESS
Toxic relationships can be a source of chronic stress. For others, it could be their job. Fast-paced, high-pressured environments with strict deadlines and micromanaging bosses may work for some people, but not everyone thrives in this type of environment. Finances are another source of stress. Chronic stress occurs from repeated exposure to stressful situations like the ones described above.
For long term chronic stress, the best remedies are grounding exercises, like yoga and meditation. Aerobic exercises that increase your heart rate, like HIIT workouts and running, are incredible stress relievers as well. These are things you can practice daily that can improve chronic stress levels. Sleep is also very important because it allows your body to rest and repair, so make sure you’re getting enough of it. 7-9 hours per night is optimal. Find your sweet spot.
References:
Emil A. Tanghetti, “The Role of Inflammation in the Pathology of Acne.” The Journal of Clinical and Aesthetic Dermatology, vol. 6, no. 9, 2013, pp. 27-35. PMID: 24062871. (Published online September 2013). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3780801/. (Accessed December 10, 2020).
Kara E. Hannibal and Mark D. Bishop, “Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation.” Journal of American Physical Therapy Association, vol. 94, no. 12, 2014, pp. 1816-1825. PMID: 25035267. (Published online July 2014). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263906/. (Accessed December 20, 2020).
University of California, San Francisco, “Blood Sugar & Other Hormones,” Diabetes Education Online, https://dtc.ucsf.edu/types-of-diabetes/type2/understanding-type-2-diabetes/how-the-body-processes-sugar/blood-sugar-other-hormones/#:~:text=Cortisol%20is%20a%20steroid%20hormone,counterbalances%20the%20action%20of%20insulin. (Accessed December 20, 2020).
Ian R. Wallace, Michelle C. McKinley, Patrick M. Bell, and Steven J. Hunter, “Sex hormone binding globulin and insulin resistance.” National Center for Biotechnology Information (NCBI) [Internet], vol. 78, no. 3, 2013, pp. 321-9. PMID: 23121642. (Published online March 2013). https://pubmed.ncbi.nlm.nih.gov/23121642/. (Accessed December 20, 2020).
Karin de Punder, Leo Pruimboom, “Stress Induces Endotoxemia and Low-Grade Inflammation by Increasing Barrier Permeability.” Frontiers in Immunology, vol. 6, no. 223, PMID: 26029209. (Published online March 2015). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4432792/. (Accessed January 14, 2021).