Yes, stress causes acne, but it’s slightly more complicated than that

As you may have discovered on the morning of your high school prom or moments before your first big presentation at work, the relationship between stress and acne is the real deal. It’s why those big, honkin’ zits tend to park themselves on your face ahead of major life moments, and seem to so generously stick around for all the photo opps.

While it’s easy to look at these frustratingly common scenarios as proof that “stress causes acne,” the real impetus behind your big day breakouts is a bit more complicated than that. It’s actually the stress hormone, otherwise known as cortisol, that’s giving your complexion grief, and there are a whole lot of things—in addition to run-of-the-mill life stressors—that can cause it to spike.

First, it’s important to understand how stress actually impacts your system, and why that tends to show up on your skin. “Stress causes a complex series of changes to our bodies.  As part of the stress response, cortisol and related hormone levels rise to prepare the body for a stressful experience,” explains New York City-based dermatologist Joshua Zeichner, MD. “As a side effect, these hormones lead to an increase in oil production in our skin promoting breakouts. They can also interfere with wound healing, prevent the skin from repairing itself, and could potentially be associated with premature aging.”

What causes cortisol to spike?

As we’ve already established, when you’re feeling mentally, physically, or emotionally stressed, cortisol spikes and ultimately tends to show up on your face. “You didn’t sleep enough and you’re under a lot of stress, therefore, your brain releases cortisol, and then that causes your skin to get really dried out and inflamed, and acne, psoriasis, and everything gets worse,” says NYC-based dermatologist Ellen Marmur, MD. “That’s called ‘transepidermal water loss,’ and it basically means that your skin barrier isn’t strong anymore and the water’s just evaporating. Then, you’re set up for infections and inflammation.” Otherwise known as acne.

But that, says Dr. Ellen Marmur, is actually only half of the story. Yes, cortisol is a stress hormone that’s released in situations that are perceived as traditionally stressful, which affects your entire body (including skin); however, skin itself can get stressed depending on what’s going on in the outside world. “Your skin reads stress in the environment based on the temperature, or pollution, or the sun, or all kinds of things.” She explains that any time that the sensory nervous system on your skin is triggered, stress hormones can be released and cause a problem on your complexion.

“It’s more like a game of ping pong, where the stress from the brain is affecting the skin, and then the stress from the skin is heading to the brain. They’re going back and forth, and back and forth, trying to achieve balance—or a steady state of normal stress,” she explains. One way to think of this is as an “infinity sign” of stress reactions happening inside your body.

In addition to the actual stress between your brain and body, there’s one other factor that could be potentially stressing out your system: your diet. “If you’re eating something that’s not easy for you to digest, you could also have a stress response, which is the cortisol hormone,” Dr. Marmur says.  “Let’s say you have gluten sensitivity. You eat gluten, and you get bloated, and you get this terrible stress response. Your skin breaks out. Your eczema gets worse. You have weird rashes. That’s how the GI tract can affect your skin in a bad way.”

How can you deal with acne caused by cortisol?

“The same tools we use for traditional acne can help stress-induced breakouts,” assures Dr. Zeichner. First things first, though: Do what you can to minimize your stress levels, whether that be exercising, yoga, or meditation.

Next, adjust your skin-care routine. “Start with an exfoliating cleanser to help keep the pores clear,” says Dr. Zeichner. “If you already have breakouts, turn to salicylic acid, which is a beta-hydroxy acid that helps remove excess oil from the skin and dries out pimples. And benzoyl peroxide is your go-to ingredient for red, angry pimples. It lowers levels have acne-causing bacteria on the skin and subsequently calms inflammation.”

If you’re still not seeing changes in your skin, it may be time to look toward your lifestyle as a whole. “You’ve got to understand it’s a lifestyle approach, a wellness approach, not just a quick fix or a diet, or a specific diet approach,” says Dr. Marmur. “If your skin is breaking out and your acne is getting worse, it’s not just because you’re not washing your face enough, or that you’re eating sugar, or that your skin is too oily. It’s also that your lifestyle can actually affect your stress, which can affect the oil glands in your skin, which can affect the acne bacterial level that you have, which can affect your acne.”

And of course, since stress causes acne and acne causes stress, take some time to chill out and your skin will likely follow suit.

Stress breakouts are one of many many different kinds of pimples, so here’s your guide to how to treat ’em all. And here’s the one way your face may be trying to tell you that your zits are, in fact, hormone related.