A Top Dermatologist Explains How Your Skin Responds to Stress

09.15.2022 — The Frenshe Editors

If you have a mirror, you’re probably all too aware that stressful times often coincide with stressed-out skin. For lots of us, acne flare-ups are the most common stress-related skin issue, but depending on your body’s response, stress can also trigger issues such as hair loss and eczema. To help us understand the stress-skin connection, we turned to Dennis Gross, MD, one of New York City’s top dermatologists, to break it all down—and to help us figure out how to cope.

As a dermatologist, can you “see” stress by looking at someone’s skin?

The visible signs of stress on the skin are redness, dry patches, dullness, tired eyes, fine lines, and flare-ups. When we’re stressed, our bodies take on a fight-or-flight response. Blood rushes to our vital organs and hormones like adrenaline and cortisol spike. Since the skin is not a vital organ, this can lead to decreased circulation, which inhibits the skin from receiving the same amount of oxygen, nutrients, and antioxidants as it usually does, making the skin’s problems appear worse.

How does the overproduction of cortisol, the “stress hormone,” affect our skin?

Spikes in cortisol can result in inflammation, collagen breakdown, and decreased circulation. The combination of these things can exacerbate autoimmune issues and lead to flare-ups for conditions such as: acne, eczema, psoriasis, rosacea, vitiligo, hair loss (Alopecia Areata), and hair thinning (Androgenetic Alopecia or Telogen Effluvium).

When you’re stressed, you’re more likely to neglect self-care, not get adequate sleep, skip exercise, and eat an unhealthy diet.

—Dr. Dennis Gross

Does cortisol also affect inflammation or do anything to the skin barrier?

As I mentioned earlier, stress triggers inflammation in the body, which can cause inflammatory conditions such as acne to flare and worsen. Cortisol depletes oil, water, and the skin’s microbiome – all things key to having a healthy moisture barrier. The skin barrier is responsible for sealing in hydration and protecting the skin from infection. However, when it’s disrupted, water loss occurs, leaving the skin dry, flaky, and more susceptible to irritation and delayed healing.

Does “stress acne” have a look?

People experiencing higher stress levels are more likely to see inflammatory pus-filled papules or nodules pop up in the oiliest part of the face (for most, this is the T-zone). A telltale sign of stress-acne is that you’ll get a cluster of new pimples all at once.

Does chronic stress affect our skin differently than an acute stress event? Or is it all pretty much the same?

Both acute and chronic stress can negatively affect overall skin wellness; it just depends on the person and how they tolerate stress. One person might have an acute stressor that causes a flare up of breakouts, while another person may be chronically stressed and experience intermittent flare-ups.

Stress today isn’t entirely avoidable and definitely not predictable.

—Dr. Dennis Gross

Beyond cortisol, stress can affect the way we sleep, eat, and exercise. If those lifestyle factors are suboptimal, how can that affect our skin in turn?

Stress often initiates a negative feedback loop. When you’re stressed, you’re more likely to neglect self-care, not get adequate sleep, skip exercise, and eat an unhealthy diet. These behaviors can disrupt your circadian rhythm, break down skin’s structure, and reduce circulation – leading to tired eyes, which appear as more wrinkles, laxity, dark circles, and puffiness. People may also find that these behaviors can aggravate existing skin issues and trigger breakouts.

When you have patients whose skin is affected by high stress levels, what’s your course of action?

I recommend investing time in activities like meditation, exercise, and getting enough sleep to help diminish stress. When your body is able to manage stress and avoid spikes in cortisol and adrenaline, your skin will look better. Unfortunately, stress today isn’t entirely avoidable and definitely not predictable. Focusing on improving lifestyle habits combined with maintaining a consistent skincare routine that incorporates niacinamide, superfoods, and adaptogens (like my B₃Adaptive SuperFoods Collection) will be your best bet to combat stressed skin.

Any suggestions on how to reduce stress while caring for our skin?

Your skin-care ritual is an excellent form of self-care because it allows you to slow down and care for your body and mind. One way to reduce stress while caring for your skin is to incorporate facial massage into your daily regimen. Facial massage has been shown to lower your heart rate and help reduce anxiety. I love adding lymphatic massage to a facial because it also increases blood circulation and encourages skin cell renewal. Another way to reduce stress during your daily skincare routine is to wind down with a face mask. Examine your skin to see what it needs that day, and then choose a mask that’s tailored to your skin’s needs. Take the 15 minutes waiting time to relax with a book, journal, or just resting.

The Frenshe Editors