Most of us are very familiar with the scourge of acne. Affecting more than 85% of the adolescent population, its greatest outbreak occurs on the face, chest and back due to those areas containing the highest number of sebaceous glands. However, stress is also known to exacerbate this condition.

With stress currently in no short supply due to the global pandemic we find ourselves living through, how best can we continue to manage both our skin and our daily skincare routine during these trying times?

Dr Mathobela, a leading specialist dermatologist and OXY’s resident skincare expert, shares her thoughts and some tips not only on the impact of stress on our skins, but also some easy to follow everyday actions we can take.

Stress and acne
Causative factors include colonization of the skin by the bacteria P. acnes, increased sebum production from the sebaceous glands, inflammation and hyper-keratinization. However, stress has for a long time been considered an aggravating factor. Not only does it exacerbate acne, but it can also worsen other dermatological conditions including atopic dermatitis, alopecia areata and psoriasis, amongst others. In fact, a study showed an improvement in acne lesions in patients receiving biofeedback training, relaxation training and stress reduction compared to those in the control group.

How exactly does stress worsen acne?

Our bodies respond to stress (emotional, physical and/ or psychological) by activating the hypothalamic-pituitary-adrenal axis (HPA). The axis is made up of the hypothalamus and the pituitary gland, both found at the base of the brain and the adrenal gland located on top of the kidneys.

In a stressful situation (especially chronic stress) adrenaline is released into the bloodstream stimulating the hypothalamus to release corticotrophin-releasing hormone (CRH) in higher amounts than normal. This in turn over activates the pituitary gland. The pituitary gland releases a hormone (adrenocorticotrophic) that activates the adrenal glands to increase secretion of cortisol (a stress hormone) to as much as four times the normal amount that ultimately leads to increased oil production. This can worsen acne. High levels of cortisol are immunosuppressive, increasing susceptibility to infections and impairing wound healing, also delaying healing of acne lesions.

CRH can be produced directly in the skin by epidermal and hair follicle keratinocytes and sebaceous gland cells. CRH works on the skin directly by stimulating sebaceous glands to increase lipid and steroid production. CRH expression in acne skins also facilitates inflammation that in turn leads to the worsening of acne.

Nerves in the skin are also known to respond to stress by releasing a hormone that stimulates the proliferation and differentiation of sebaceous glands-leading to up regulation of lipid synthesis and inflammation.

Acne in the time of COVID-19

Not only are one’s stress levels significantly higher due to the pandemic and its consequences but having to wear masks increases heat and humidity on the skin. This exacerbates blocking of the pores in turn creating a fertile environment for bacteria to flourish, leading to what is known as ‘maskne’. Masks can also lead to mechanical stress due to friction that causes irritation, resulting in inflammation and aggravation of acne.

Stressful times can also lead to comfort eating, with many perhaps consuming foods thought to increase acne during stressful times.

So, what to do about it?

Cleanse and Treat! Every. Single. Day.

Now more than ever it is important to follow a good skincare routine. This involves washing one’s face twice a day with a gentle cleanser and moisturising with a skin type appropriate moisturiser. Important to note; limit scrubbing and/ or exfoliating on acne, worsened by mask wearing, as the skin is sensitive.

Try to minimise external skin stressors such as UV exposure (apply sunscreen regularly), irradiation and air pollution (use antioxidants such as Vitamin C) and mechanical factors (wear proper fitting face masks and do not squeeze pimples).

Benzoyl peroxide can help for inflamed acne lesions and retinoids, under the guidance of a dermatologist, can also be helpful.

Wear a clean mask daily and, whenever possible, be sure to give your skin a break (away from others and always social distancing). And remember, exercise regularly and take part in any other activities known to help reduce stress levels.