Stress can trigger acne by increasing oil production and clogged pores. For people with skin-picking disorder or OCD, stress acne can exacerbate cycles of picking and anxiety.
You may notice clogged pores, inflammation, and, ultimately, breakouts when you’re experiencing high levels of stress, particularly around areas like the forehead, chin, and jawline. This type of acne, often referred to as stress acne, is a common skin issue that can affect people of all ages.
Breakouts can be caused by factors like hormonal changes, nutrition, lifestyle choices, and stress. Stress, in particular, can be a significant trigger for acne in adults. Generally, acne is caused by blocked hair follicles under the skin, clogged pores, or dead skin cells. However, your skin produces more oil in response to increased cortisol levels (stress hormones), which can also contribute to acne.
Acne might be especially difficult and triggering for someone with skin-picking disorder— a condition that involves compulsive skin picking, often as a response to stress or anxiety. The presence of breakouts can exacerbate the urge to pick, leading to further irritation, scarring, and a cycle of worsening acne. Skin picking can be connected to mental health issues, such as obsessive-compulsive disorder (OCD), or body-focused repetitive behaviors (BFRBs).
In this article, we’ll review how stress is connected to acne, what you can do to treat it, and what to do if you’re experiencing compulsive skin-picking.
Does stress cause acne?
“Acne can be increased or worsened by psychological stressors,” says MaryBeth Overstreet, MA, LPC. A 2017 study found that stress may contribute to the development or worsening of acne, with 50 to 80 percent of participants reporting that emotional stress aggravated their acne. Another study found that medical students who reported greater stress also had increased acne severity.
The body’s stress response triggers the release of cortisol, a hormone that helps regulate the fight-or-flight response. While cortisol is essential for managing stress, prolonged or excessive levels can lead to increased oil production in the skin, contributing to clogged pores and, ultimately, acne. The body also produces more androgen hormones, which stimulate glands in our skin to produce even more oil, further increasing the risk of clogged pores and breakouts.
What does stress acne look like?
Stress acne doesn’t look physically different from other types of acne. However, stress can cause acne to heal slower, last longer, or become more severe.
Generally, stress acne can develop in areas like the forehead, face, chest, back, and shoulders. Although acne can occur at any age, it is most common among teens and young adults.
How is stress acne treated?
Skin treatment
If you’re concerned about your skin, you should see a dermatologist who can identify what kind of acne you have as well as the best treatment option. They might recommend oral medications or topical treatments like gels, creams, and cleansers, either by prescription or purchased over-the-counter.
- Antibiotics are taken orally to help slow bacterial growth that causes acne.
- Benzoyl peroxide is a topical medication that breaks down bacteria that causes acne.
- Retinoids are topical medications that help to reduce inflammation of lesions and scarring.
- Salicylic acid is a topical, anti-inflammatory treatment that sheds dead skin and dissolves excess oils that clog pores.
Stress management
Reducing stress is easier said than done. Learning healthy stress management is good for your health overall, and this often involves making intentional changes to your daily lifestyle routine.
For example, getting enough sleep is essential—lack of sleep can worsen stress, impact your mood, and cloud your thinking. Regular physical activity also helps manage stress by releasing endorphins, which boost your mood and reduce anxiety. Reaching out to friends, family, or a therapist can provide valuable emotional support during challenging times.
If you’re finding it difficult to cope with stress on your own, seeking professional help can make a big difference, especially if stress is causing you to pick at your skin, which may indicate an underlying mental health issue.
What is skin-picking disorder?
In response to stress, some people engage in picking their skin, as a self-soothing behavior that relieves negative emotions and tension, or as a self-stimulating behavior when feeling bored or understimulated. Stress acne flare-ups can be particularly triggering for people with skin-picking disorder.
Skin-picking disorder (also known as excoriation disorder or dermatillomania) is characterized by repetitive touching, picking, rubbing, or digging into one’s skin, often in response to stress or anxiety. People with skin picking disorder may have an intense urge to scratch, pick scabs, or pop pimples on their faces and bodies.
Skin-picking disorder is classified as a body-focused repetitive behavior (BFRB), an umbrella term that causes people to engage in repetitive behaviors fixated on their body, such as hair-pulling, nail-biting, or cheek-biting.
Sometimes, skin-picking can be connected to OCD, a chronic mental health condition characterized by obsessions, which are recurrent and intrusive thoughts, urges, feelings, sensations, or images that cause anxiety. In response to these obsessions, someone with OCD does compulsions, which are repetitive behaviors or mental acts in an attempt to neutralize their thoughts or decrease distress.
It can be challenging to figure out whether you have skin-picking disorder, OCD, or both.
“It is not uncommon for most people to pick at their skin,” Overstreet says. “BFRBS are done in response to physical sensation or general tension, and to decrease distressing emotions like stress. On the other hand, someone who has OCD is going to have intrusive thoughts, images, sensations and want to do a safety seeking behavior.”
BFRBS are done in response to physical sensation or general tension, and to decrease distressing emotions like stress.
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Over time, skin-picking disorder can create a cycle, where the desire to relieve emotional tension through skin-picking only leads to further damage, scarring, and increased embarrassment. This cycle can significantly impact self-esteem, making it harder to break free from the behavior without proper support and intervention.
Treating skin-picking disorder
Habit-reversal training (HRT) is a treatment option for BFRBs like skin-picking disorder. This involves awareness training, or helping someone who is doing repetitive behaviors, to become aware of their behavior and triggers.
For example, you might notice that when you’re bored, stressed, or anxious, you’re more likely to start picking your skin. By becoming more aware of these moments, you can begin to interrupt the behavior before it escalates. HRT also involves developing alternative responses to picking—such as squeezing a stress ball or using a fidget toy—so that you have a new coping mechanism to turn to.
Social support can also help significantly in managing a skin-picking disorder. Having a supportive network of family, friends, or support groups can provide emotional encouragement, reduce feelings of isolation, and help hold you accountable in your efforts to manage the behavior.
Treating symptoms of OCD
If your skin-picking compulsions are related to OCD, exposure and response prevention (ERP) therapy is the most effective treatment option. Working together with a trained therapist, you’ll confront your intrusive thoughts, while resisting the urge to perform compulsions.
Through ERP, you’ll gradually face situations that trigger your anxiety without resorting to compulsive behaviors, allowing you to build tolerance to the discomfort and reduce the intensity of your intrusive thoughts over time.
When OCD and BFRBs are present together, a combination of ERP and HRT is often used. While ERP focuses on managing anxiety and compulsions, HRT helps you replace the picking behavior with healthier alternatives. By working with a trained therapist, you’ll gradually face the triggers of your anxiety and reduce intrusive thoughts, all while learning strategies to prevent skin-picking.
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All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
Bottom line
Stress can worsen acne, so if you’re concerned about breakouts, it’s a good idea to consult a dermatologist. However, if you struggle with skin-picking disorder and/or OCD, seeking help from a therapist trained in ERP or HRT is crucial for effective treatment.
Key Takeaways
- Stress can exacerbate acne by triggering the release of cortisol and slow down the healing process of acne, making breakouts last longer or become more severe.
- Skin picking disorder is a body-focused repetitive behavior that is often linked to anxiety and stress. Stress-induced acne can worsen the urge to pick at the skin, leading to a cycle of irritation, scarring, and further breakouts.
- Managing acne caused by stress can include skincare treatments as well as stress management strategies like exercise, sleep, and seeking social support. For those with OCD, ERP therapy can help break the cycle of behaviors that worsen both stress and acne.