How Does Stress Correlate with Facial Acne?

How Does Stress Correlate with Facial Acne?

Sabrina Schrope

Cosmetic Chemist, Owner of Vitamin You

 

Introduction:

         Acne is one of the most common chronic inflammatory skin diseases at an estimated 80-90% of the general population being affected at some point in their life.1,2 The majority of which develops in adolescence but can reoccur in adulthood among all ages, sex, and ethnicities. Many lifestyle factors can influence acne symptoms including stress, sleep, diet, and medications.3 In this article, only the effect stress has on acne will be investigated. What once was considered anecdotal, is now being thoroughly studied to determine how the stress response correlates with the onset and worsening of acne.

 

Discussion:

         An early study conducted in 1991 considered possible psychological factors regarding acne. They theorized that these three concepts were important for researchers to consider:4

  1. Emotional stress can worsen acne.
  2. Vice versa: Acne can worsen emotional stress.
  3. Obsessive-compulsive disorders can also be directed at skin picking and acne exacerbation.

It is important to keep in mind that not only can stress lead to the onset acne, but also that acne can create a stress cycle which then creates more emotional distress. This was also a time when “glucocorticoids” and “androgens” were linked to worsening acne as it related to adrenal hormones. They suspected that stress hormones were elevated in the blood leading to worsened acne.4

 

         More recently, a 2014 analysis in Berlin theorized how acne could be caused by “modern life” stressors. Specifically, they recognized social pressures, sound and light disturbances, work and finances, and child raising as sources of psychological stress. More importantly, they stated that stress-related genes are expressed more for acne-prone skin types than non-acne-prone skin types.3 However, whether it was the chicken or the egg (stress or acne) that came first was not determined.

         Regardless, the genes expressed when under psychological stress are responsible for releasing “corticotropin-releasing hormones,” or CRH proteins. These proteins influence attention, appetite, and further stress hormone secretions including skin lipid (sebum) synthesis. This team suspected that instead of elevated blood hormones causing acne, that the sebaceous glands and CRH were responsible for producing a neuropeptide called “Substance P” directly onto the skin. It alone, in vitro (on skin cells in a lab), can cause disruptions to otherwise healthy skin cells. Not only that, but they also suggested with poor sleep, stress levels can increase to worsen the cycle.3 Does lack of sleep and increased oil production caused by stress lead to acne?

 

         The 2014 researchers in Berlin must have missed the 2007 self-reporting study done in Singapore where they conducted a study among 94 teenagers during exam week and summer vacation on the link between stress and acne. First, they found that 95% of males and 92% of females rated a positive correlation between stress and low-grade acne. Second, they established that between the periods of low and high stress, the sebum production did not change. From this, it is understood that it is not the quantity of sebum, but the composition of it that worsens acne.2

 

         Furthermore, a study in France conducted in 2015 gathered data from 2,000 15–24 year-olds via online survey regarding the consequences of acne on stress and sleep. They did not find a link between lack of sleep, hours of sleep, nor sleep disorders; but rather, a connection between acne and waking up feeling fatigued. Furthermore, stress and sleep had no effect on the severity of acne. It seemed that the degree of stress did not correlate with the degree of acne someone had.5

They also clarified the stress response into two different systems. Most commonly known are the adrenal glands producing cortisol. However, lesser understood, is also the neuropeptide production through the skin.5 This begs the question: Does “Substance P” correspond to out-of-the-lab (in vivo) skin damage from stress?

 

         To find out, a team in Poland investigated the link between stressful events and serum concentration in 2016 with 120 patients who were 18-34 years old. Among all the patients with mild to severe acne, data showed elevated levels of “Substance P” present in their sebum. Again, their research suggests that the degree of stress does not correlate with the degree of acne. It did, however, find that acne-prone patients were influenced by stress by secreting “Substance P” proteins.6

         Substance P has been recorded to induce the inflammation response and decrease cell proliferation and differentiation.1 Proliferation is the body’s way of wound healing and producing healthy cells and matrix. Differentiation is the “maturing” of skin cells into a uniform brick wall pattern as it gets pushed towards the outer layers of the skin. By disrupting these two important functions, the skin barrier becomes susceptible to an imbalance of microflora where Propionibacterium acnes can further worsen acne.1, 3 

 

 Conclusion:

         Stress is almost inevitable in today’s society as it can be triggered by finances, societal pressures, work, and urban disturbances.3 Our current understanding of how stress is linked to acne is focused on the production of two neuropeptides that are secreted by the sebaceous glands. These two proteins, “Substance P” and CRH, can be found in healthy skin, but are elevated in the sebum of those with acne-prone skin.1,3,6 Together they are responsible for disrupting skin cell proliferation and differentiation. It has also been found that the degree of stress does not correlate with the degree of acne.5, 6 Nor does poor sleep and the amount of oil produced share a link with worsening acne too.2, 5 Now that there is an understanding of how stress and acne are linked, it may be possible to avoid the consequences with stress-level-reducing activities and therapies.

 

Citations:

  1. Jović, A., Marinović, B., et al. (2017). “The impact of psychological stress on acne.” Acta Dermatovenerologica Croatica, 25(2), 133-133. Preuzeto s <https://hrcak.srce.hr/185020>.
  1. Yosipovitch, G., Tang, M., et al. (2007). “Study of Psychological Stress, Sebum Production and Acne Vulgaris in Adolescents.” Acta Dermato-Venereologica, 87(2), 135–139. doi:10.2340/00015555-0231. <https://sci-hub.st/https://doi.org/10.2340/00015555-0231>.
  1. Albuquerque, R. G. R., Rocha, M. A. D., et al. (2014). “Could adult female acne be associated with modern life?” Archives of Dermatological Research, 306(8), 683–688. doi:10.1007/s00403-014-1482-6. <https://sci-hub.st/https://link.springer.com/article/10.1007/s00403-014-1482-6>.
  1. Koo, J. Y. M., & Smith, L. L. (1991). “Psychologic Aspects of Acne.” Pediatric Dermatology, 8(3), 185–188. doi:10.1111/j.1525-1470.1991.tb00856.x. <https://sci-hub.st/https://doi.org/10.1111/j.1525-1470.1991.tb00856.x>.
  1. Misery, L. Wolkenstein, P. et al. (2015). “Consequences of Acne on Stress, Fatigue, Sleep Disorders and Sexual Activity: A Population-based Study.” Acta Derm Venereol. 95: 485-488. doi: 10.2340/00015555-1998. <https://medicaljournalssweden.se/actadv/article/view/5732/8645>.
  1. Rokowska-Waluch, A., Pawlaczyk, M. et al. (2016). “Stressful Events and Serum Concentration of Substance P in Acne Patients.” Annals of Dermatology. 28(4): 464-469. <https://synapse.koreamed.org/articles/1094756>.
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