Can anxiety cause acne?
Anxiety doesn’t directly cause acne. The stress caused by behaving anxiously, however, can contribute to acne problems.
For example, research has shown a direct correlation between periods of elevated stress and worsening acne. "When you already have acne and you get into a stressful situation, that seems to be when your acne really flares up,” says Lisa A. Garner, MD, FAAD, a clinical professor of dermatology at the University of Texas Southwestern Medical Center.
A 2003 Stanford University study published in the Archives of Dermatology found that college students had acne flare-ups during more stressful periods, such as exams, as compared to less stressful periods, such as without exams. The correlation between elevated stress and acne severity is strong.
This research agrees with what we know about anxiety, the stress it causes, and how that stress affects the body. Here are five reasons why behaving anxiously and the stress it causes can aggravate acne:
1. Stress causes sebum-producing cells to produce more oil. This increased production of oil can more easily clog hair follicles allowing for acne to form.
2. As part of the body’s emergency readiness changes, stress causes blood to flow away from the skin and to parts of the body more vital to survival. Reduced blood available to the skin can cause skin problems, such as aggravating acne. Here’s why:
Blood contains both Red Blood Cells (RBC) and White Blood cells (WBC). White Blood Cells are officially known as Leukocytes. Leukocytes are involved in defending the body against infective organisms and foreign substances. Leukocytes are quite remarkable. They are independent; move about on their own; fight against, capture, and carry away “foreign” invaders; and clean up the aftermath of dead cells after the battle is over.
Leukocytes are the principal components of the immune system and function by destroying "foreign" substances such as bacteria and viruses. When an infection is present, the production of WBCs increase. If the number of leukocytes is abnormally low (a condition known as leukopenia), infection is more likely to occur and it is more difficult for the body to get rid of the infection.
Persistently elevated stress can cause the blood to be continually shunted away from the skin. When the skin is constantly deprived of a generous supply of blood, it can be more susceptible to irritations, rashes, sores, and infections. This is one of the reasons why acne conditions generally worsen as stress increases.
3. Stress suppresses the body’s immune system, which can adversely affect the body’s ability to fight off intruders. This reduced ability can make it easier for intruders to take hold and aggravate an existing acne condition.
4. Stress causes an inflammatory response in the body, which can cause the walls of pores to break. This can cause the body to respond with redness around the broken pore and an influx of pus (a zit). 
5. Anxious personalities are more likely to ‘pick’ at their blemishes when overly anxious and stressed. Oftentimes picking at, squeezing, and ‘popping’ blemishes makes them worse and more susceptible to irritation and infection, since the body’s immune system is impaired.
Any one or combination of the above can contribute to worsening acne as a result of behaving anxiously.
While addressing your anxiety issues and reducing stress may not eliminate acne problems, they can help reduce them.
Working with an experienced anxiety disorder therapist is the most effective way to eliminate issues with anxiety and the stress they cause.
- Lisa Garner, M.D., F.A.A.D, Dermatologists in Garland, Texas.
- Stanford Medicine, Dermatology news archive
The combination of good self-help information and working with an experienced anxiety disorder therapist, coach, or counselor is the most effective way to address anxiety and its many symptoms. Until the core causes of anxiety are addressed - we call these core causes the underlying factors of anxiety - a struggle with anxiety unwellness can return again and again. Dealing with the underlying factors of anxiety is the best way to address problematic anxiety.
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Authors: Jim Folk, Marilyn Folk, BScN. Last updated July 2016.