Written by Lexie McPhee | Wednesday, 10 May 2023
Stress is one of the most common drivers of acne that I see in my clinic. In fact, the longer I am in practice, the more obvious it becomes that the root cause of acne often lies within the psychological and emotional health of the person.
It is a little known fact that during embryonic development in utero, the tissues that become the epidermis (skin) hair and nails all develop from the same cell line that generates the central nervous system and associated tissues. From the very beginning, our skin and nervous system are intricately linked.
Human skin is not just a mechanical barrier separating the body from the world outside, but it is also a neuroendocrine organ – it is able to respond to stimuli from the nervous system by producing its own version of stress and sex hormones such as cortisol and testosterone.
In short, the skin can adapt its function in response to messages of stress (whether real or imagined) from the brain and central nervous system. Fascinating!
A nervous system that is sympathetic dominant (in fight or flight mode consistently) will increase the amount of adrenaline and cortisol (stress hormones) produced within the adrenal glands. The skin will respond to cortisol by producing thicker and stickier skin oil (all the better to protect you with, my dear!) and by increasing keratin protein production, leading to the formation of keratin plugs and the subsequent inflammation and development of acne lesions. Skin activation by cortisol can also lead to an increase in oxidative stress, inflammation, and impaired barrier function of the skin. Given that the pathophysiology of acne is characterised by excessive sebum, keratin, and the infection of blocked pilosebaceous units in the skin, the causative link with stress is clear to see.
Existing acne can also be exacerbated by acute episodes of emotional stress (like embarrassment, grief, fear, frustration, and anxiety) as negative emotions are associated with an increase in production and release of histamine. Histamine is an accelerant – it amplifies other processes in the skin. It will ramp up inflammation, redness, swelling, itching, heat, and pain. For this reason, a part of my consultation and treatment approach centres around stress management and emotional health – our thoughts can trigger feelings which set off biological processes in our skin. One way in which to know whether fluctuating emotions are affecting your skin is to note whether your skin is relatively calm and clear on waking, but gets red and inflamed throughout the day, looking the most severe in the evening. This is a huge flag that stress hormones are flaring up your skin.
So, while stress and nervous system activation can have acute effects on acne, chronic exposure to low grade stress can also contribute.
This is because elevated cortisol in the long term can affect insulin and blood glucose regulation. Stress is often a factor in insulin resistance, which drives androgenic acne (such as PCOS acne, post-pill acne and teenage acne conditions)
When the thecal cells in the ovaries are exposed to elevated levels of insulin over an extended period of time, they tend to swell and enlarge. Thecal cells are responsible for testosterone production in the ovaries. Bigger cells produce more testosterone! High testosterone can inhibit ovulation, further disturbing hormonal balance. Given that the stress response and blood sugar response are so intimately connected, it is practically impossible to restore one response without also working on the other.
Most clients that I work with are unaware of just how much stress they are really under. Our system has a clever way of normalising our perception of stress in order to cope. Sometimes, when high stress is the norm, only extreme events such as panic attacks where you literally feel like you might die will register as stressful moments. I have even had clients who report panic attacks but will then go on to say “but I don’t feel stressed”. There are also sources of stress that we do not consciously perceive, but which our body responds to as a potential threat. This can include even seemingly beneficial practices such as fasting.
In a person who is already subject to a high amount of psychological or physical stress, fasting can exacerbate the body’s fight or flight response. Unless you’re getting up to eat a midnight snack, by breakfast time, most people have already ‘fasted’ for a good 8-10 hours. To extend this period of fasting whilst rushing to work, training at the gym or drinking coffee can cause blood sugar levels to drop below normal. To stabilise blood sugar levels until energy is provided in the form of food, the adrenal glands pump out cortisol to raise blood sugar. Skipping meals and fasting is a detrimental practice especially for people suffering from stress driven acne.
It goes without saying, that to heal from hormonal acne, stress management and nervous system health must be prioritised. Your nervous system needs to feel as safe as possible and this goes beyond your conscious, logical mind! In cases of stubborn acne that is not responding to usual measures, healing will usually occur when unresolved trauma and repressed emotions are finally processed and moved from the body. When ignored, these parts of us keep us in a hyper-vigilant, state to protect us from further harm. Overcoming this obviously requires support from a practitioner who is trauma-informed and experienced in somatic healing.
There are many options to explore when working to restore nervous system safety and emotional health, such as emotional release acupuncture, emotional freedom technique, somatic experiencing, theta healing, hypnotherapy and more. In acne cases where stress is clearly a huge cause, I will sometimes recommend prioritising the above modalities as even more important than hormone testing or herbal supplementation! True healing asks us to go deep, and that usually leads us into some very interesting places. It’s well worth the effort.
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Lexie is an Endeavour College of Natural Health Alumni and online Naturopath. Her 100% online clinic and e-courses have enabled her to relocate to sunny Portugal whilst still serving her clients worldwide. She focuses on supporting women with acne and mentoring new Naturopaths in the treatment of skin conditions. Her current research obsession is metabolic nutrition and bio-energetic health.