Have you ever noticed that when you’re really stressed out, your body tends to reflect that? When your to-do list is endlessly piling up, it’s prime time for pimples to populate your face, which leads you to stress about your blemish(es)—which can result in even more breakouts. It’s a vicious cycle.

Yet there’s science behind it. Just as stress affects your brain, it affects your body—and, even worse, can get in the way of clear skin.

Abigail Waldman, MD, a dermatologist from Brigham and Women’s Hospital in Boston, discusses the serious side effects with Allure—and offers tips on preventing the skin woes that are bound to happen when you’re feeling overwhelmed.

Read on for the six ways stress can affect your skin.

1. It can lead to scarring

Some people have nervous behaviors when they’re stressed—biting your nails, ripping apart your split ends, and picking your skin, for example. “Tic behaviors [like these] can cause serious skin problems,” says Waldman. “There are people who cause their own balding from pulling out their hair, which is [a disorder] called trichotillomania.”

Sometimes these so-called tic behaviors are done subconsciously, so it can be tough to control—but they can lead to permanent scarring. Try using a stress ball or meditating instead, and do as your mom has probably told you a zillion times—don’t pick!

2. Stress can worsen preexisting conditions

If you have a skin condition like psoriasis or eczema, you may have noticed that they flare up when you’re really anxious or stressed. Waldman points out that beneath your skin’s unstable mode is a burst of the hormone cortisol, which can take a toll on your immune system and wreak havoc on your previously blemish-free face.

3. It can get in the way of your social life

Are you one of those people who wants to hide out when your skin’s breaking out? (I’m with you.) “Patients who have skin conditions have been shown to have higher instances of anxiety and social avoidance,” says Waldman. “It’s all interconnected in that stress and anxiety can impact skin conditions, and having skin issues can lead to anxiety and negatively affect someone.”

4. Fine lines can appear

Some people joke that certain bouts of stress age them. There’s actually some truth to that—New York-based dermatologist Kavita Mariwalla tells Allure that angst have a damaging effect on DNA inside the cells. “Telomeres—which are caps at the end of each strand of DNA, kind of like the plastic tips on the end of shoelaces—that protect our chromosomes and affect how fast our cells age are shorter in people with stress,” she says. “And as telomere length shortens, cells die off or become damaged.”

5. Inadequate zzz’s can make it worse

We know sleep is a big factor in our well-being (just ask Arianna Huffington). But it turns out that not getting enough sleep can show up on your face. Waldman says that swollen eyes, dark circles, and increased signs of aging are all physical consequences of not getting sufficient sleep. Sleep is “a time when we tell patients to use medications that can also work to repair skin,” she says. Mariwalla recommends a facial moisturizer that has caffeine, which tightens the skin around your eye area if you’re having trouble clocking eight solid hours of sleep.

6. Your hair could start falling out

The condition is called telegon effluvium, and occurs because your hair stops following its usual pattern of growing and falling out when you’re super-stressed. Some doctors think that if your body sees anxiety as a threat, it could possibly view growing hair as unnecessary (scary!). The good news is that your healthy hair patterns will resume in more calm times. To help prevent hair loss, Mariwalla recommends eating at least 20 grams of protein a day and consider taking prenatal vitamins.

Stress doesn’t have to be harmful, actually—if you know how to use it to your advantage. And here’s how to treat anxiety the natural way.