Keep Calm And Get Fewer Spots: The Stress-Acne Link

We’ve all experienced it before: you go through a period of higher than usual stress and, as if from nowhere, spots start appearing on your typically blemish-free face. The reasons behind this stress-acne link are what we’ll be looking at in this article.

Let’s start with a quick overview of how a spot forms…

The Birth Of A Spot

The birthplace of an acne spot is a hair follicle and humans have around 5 million of them covering almost every inch of skin on their body. These tiny holes in our skin are lined by cells and have oil (sebum) producing glands which keep the skin and hair conditioned.

The first stage of a spot occurs when the opening of the follicle gets blocked. A growing hair typically pushes dead cells and excess sebum out of the follicle, but when there is an excess of cells or they stick together too much, they form a plug across the opening.

Once blocked, as more cells and sebum get pushed into the follicle, it starts to swell. At this point there is a low oxygen level in the follicle. This makes conditions ideal for the acne bacteria to thrive, thus increasing swelling and inflammation as the white blood cells of the immune system attack the bacteria.

The combination of dead cells, sebum and bacteria form the basis of both whiteheads and blackheads.

How Stress Can Exacerbate Acne

Now that we’ve graduated acne formation 101, let’s take a look at the factors that link increased stress levels with the formation of spots.


Androgens are hormones that are present in both men and women; they play a role in various male traits (thus males have more than females in general).

Androgens contribute to acne in various ways, the most important of which are the increase in sebum production, the proliferation of skin cells in and around the follicle, and increased inflammation.

The direct relationship between stress and androgen levels is somewhat mixed. On the one hand, levels of testosterone in men (the most important of their androgens) are reduced during the stress response. On the other, the adrenal gland produces more of the other types of androgen at the same time. It is likely that stress increases the cumulative level of the various androgens in the bloodstream.


In a short term stressful situation, the amount of insulin circulating throughout your body is reduced. This is because insulin’s main function is to reduce glucose levels in the blood by stimulating cells to absorb and convert it for a later date; in a fight or flight situation, our bodies need that glucose for energy.

However, chronic stress over a period of days or weeks has the opposite effect. When we eat, food is broken down by the gut and glucose is one of the results. Insulin is then secreted by the pancreas to ensure that this glucose gets stored away in our cells.

So we have the body trying to perform its natural function of storing the energy we get from food working against the stress response which wants to keep that energy readily available.

Eventually the pancreas wins the battle, and it does this by producing ever higher amounts of insulin. What stress does, then, is to lower your body’s insulin sensitivity, which, in some cases, leads to insulin resistance and eventually diabetes.

Here’s the thing; insulin induces the production of androgens, which, as we have seen, are major players in the worsening of acne. So as your insulin sensitivity reduces, your body has to produce more of it, which leads to greater basal (base layer) levels of androgens.

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Insulin-like Growth Factor (IGF-1)

There is an even more important role to play for a hormone that is similar in many ways to insulin, but that has a more direct impact on acne.

Production and secretion of Insulin-like Growth Factor or IGF-1 correlates with that of insulin, so chronic stress is highly likely to lead to an increase in IGF-1 in your body.

More IGF-1 also leads to more androgens, but it also acts more directly on the skin by stimulating the production of sebum and increasing the sensitivity of the skin to the androgens being produced.

The crux of the matter is that a prolonged activation of the stress response leads to a greater level of these acne-worsening substances in your blood.

How Important Is Stress Versus Other Factors?

As you may have already guessed, there are other factors at play when it comes to the production of the hormones mentioned above.

  • Our genes – some people are simply more predisposed to getting spots thanks to their genetic makeup and the effect this has both on their hormones and their cells/glands.
  • Natural variability across our lifetimes – levels of androgens do not stay constant through life and the most obvious demonstration of this is puberty. During puberty, the body produces far more of these hormones to stimulate the changes that take place. This is why acne is most prevalent among teenagers. As we get older, our bodies typically produce lower amounts of androgens.
  • The foods we eat – insulin is designed to maintain our blood sugar levels at a healthy level. Depending on the amount of glucose being produced in the gut, the levels of insulin required to achieve this will vary. Eat a very sugary snack or a meal rich in refined carbohydrates and your blood sugar level will rise much more rapidly, which will, in turn, cause more insulin to be secreted.
  • Medical conditions – there are a number of conditions that can lead to more or less androgens or insulin being produced and these will directly impact the amount and severity of spots experienced.

While stress can only lay claim to affect parts of the overall process of spot formation, it can certainly make it more likely and more severe for sufferers.

One unfortunate fact of life is that acne typically makes us more self conscious, which manifests itself as an activating of the stress response at higher frequencies. Thus, stress and acne can form a vicious cycle or spiral as one worsens the other.

The Conscious Rethink: as with many things, knowledge is a great weapon in the fight against acne. Once you realize that stress can play a significant role in acne spots, you can aim to tackle it more proactively with clearer skin being just one of the beneficial outcomes.

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