Women, Stress, and Acne


Today’s blog is inspired by an interview request I received from the UK concerning the significant rise in adult women visiting their dermatologist for acne. It is absolutely true that our hard economic times, and the general ‘bad’ news coming from all sectors, internationally as well as domestically, is contributing to a major increase in acne flare ups.

Stress is a proven precipitator of acne. Yes, men also suffer from stress, but because of their hormonal differences, adult women are much more adversely affected. Recent statistics from the American Dermatology Association report that the median age for patients suffering from acne has been gradually increasing. Earlier it used to be 20.5 years, whereas now it is approximately 26.5 years or age. More than 17 million adults are diagnosed with acne in the US, of which 50 % are adult women and 25% are adult men.

It is a sad but true fact that acne often rears its ugly head at the most inopportune times possible. Acne has an uncanny knack for flaring up just in time for that big date, job interview, wedding day or other special event in our lives. This happens with alarming frequency – far too often in fact to chalk it up to “bad luck” or coincidence. There is a physiological reason for these untimely flare-ups and its name is stress.

Of all of the physical conditions we experience, stress is the most deadly. Many circumstances create stress in our daily lives. Arguing with family, friends or colleagues, not getting enough sleep, worrying, working too hard or even playing too hard can all create stress. Weekend warriors, who try to make up for a week of inactivity by spending hours engaged in strenuous physical sports, raise their stress levels to an unhealthy degree. Any activity that is practiced without moderation can lead to a stress response. This is extremely important to remember if you hope to gain control of your acne flare-ups.

For those of you familiar with my work in the anti-aging field, you know that elevated levels of the hormone, cortisol (also referred to as the ‘death’ hormone) are very destructive to the body. Elevated cortisol levels cause an increase in blood sugar. This in turn causes an instant response from our cells as they enter an extreme pro-inflammatory mode. Because acne is a systemic, inflammatory disease, any increase in inflammation will result in an increase in the length and severity of the outbreak.

Mars vs. Venus, Androgens and Acne
When our blood sugar and insulin levels rise, whether from a poor diet or from stress, we experience a serious increase in inflammatory chemicals at a cellular level. This causes inflammatory diseases such as acne to worsen dramatically. Cortisol and other adrenal steroids can act as androgens and stimulate the sebaceous (oil) glands resulting in a flare-up of acne. Although men are affected by stress and pro-inflammatory cortisol response, women suffer from both the pro-inflammatory cortisol-sugar-insulin connection, as well as the effect of the male-type hormones. Men are not affected from high levels of androgens in the same way that women are. Women are most susceptible to adrenal hormone stimulation because most of the women’s androgens are synthesized in the adrenal glands. The stimulation of the oil glands results in changes such as the clogging of the pores and increased secretion of pro-inflammatory fatty acids. These pro-inflammatory fatty acids release the chemical messengers known as cytokines, and so the inflammatory fire is fed. Men with high levels of androgen circulating do not suffer from the androgen affect like women.

The Top Ten

But the news is not all bad. We can learn how to lower cortisol levels and stop acne before it starts. Follow these simple rules and you will enjoy lowered stress levels, increased energy, elevated moods and sense of well-being and clear, radiant skin.

1. Follow the anti-inflammatory diet,
2. Make sure that you get enough sleep
3. Try to minimize stress in your life
4. Don’t drink coffee. Coffee contains many organic acids which affect our blood sugar and cortisol levels. It is not specifically because of the caffeine because you can drink a cup of decaffeinated coffee at 8 AM and your cortisol levels will still be measurable at 10 PM –the same effects as a cup of regular coffee.
5. Set aside time for meditation, prayer or a walk in Nature. It is a well- established fact that people who do this have significantly lower cortisol levels. Long term benefits include keeping our skin clear, maintaining a healthy immune system and preventing age-related diseases, such as diabetes, cancer or cardiovascular disease
6. Consider learning some simple Yoga exercises. Substitute green tea for coffee.
7. Make sure that there are plenty of essential fatty acids in your diet because essential fatty acids can decrease cortisol levels.
8. Take nutritional supplements including alpha lipoic acid, zinc, DMAE, pantothenic acid.
9. Add essential fatty acids such as borage and evening primrose oil which are rich in linoleic acid. Acne sufferers have a low concentration of linoleic acid in their sebum and the levels decrease as the acne increases.
10. Adopt a loving, non-judgmental pet

I have often wondered how so many of Hollywood’s most stunning faces manage to have such clear complexions, given the high level of stress in the entertainment industry. The answer may be that a great many of them are huge pet lovers. Think Oprah, Jessica Alba, Heidi Klum, Rachael Ray, Paula Abdul, Jessica Biel, Julia Roberts, Demi Moore, Elizabeth Taylor, just to name a few. Perhaps this is the ideal ‘prescription,’ for beautiful, luminous, acne-free skin.

As an active researcher, I welcome your comments and suggestions.

View PerriconeMD acne products here

11 thoughts on “Women, Stress, and Acne

  1. Thanks for this! After 35 years of perfect skin, I developed cystic acne. Ten years later, it’s better but still flairs up with stress. I find that Jojoba oil calms it quickly.

  2. Hi Dr. Perricone,

    Do you recommend krill oil above fish oil, due to it’s bioavailability (phospholipid)?

    Also, if I take zinc, do I also need to simultaneously take copper?

    For panothenic acid, I was under the impression that if you take 1 B-vitamin, you should take them all. Is this true?

    I have your book, The Perricone Prescription. I am confused as to why steel cut oats are part of the diet. They are shown to be inflammatory.

    I look forward to your responses!

  3. I am suffering from cystic acne and am also 4 months pregnant. Do you believe it is safe for me to use your skin clear line? Also, how long does it take on average to see clearer skin with the use of your skin clear product line? Since I am currently pregnant, I do not feel comfortable using the supplements, so I realize I may not see results as quickly as I would if I were able to take the vitamins.

  4. Dr. Perricone:
    I am a 57year old woman still having acne!!!!!! I have been going to dermatologists for years, have been on antibiotics in the past (which was the only thing that helped), and have tried all the topicals on the market (prescription), taken acutane, etc, and still have acne. I cannot take antibiotics anymore because I am resistant to them. Recently, I have had quite a flare up because of stress in the family (aging parents, sickness in family, etc.). I went to the yellow pages in the phone book and found a place called “Advanced Laser Medspa” and one of the things they specialize in is adult acne. So far they have helped me. The treatment is dermabrasion and products from Obagi: Clenziderm M.D. (pore therapy Salicylic acid 2% and Serum gel Benzoyl Peroxide 5%. It is helping but my gut feeling is that it is only temporary.
    I bought your book “The Acne Prescription” and it sounds promising for me. If you get to personally read this note, could you please pare down the products and supplements that you think I should purchase from your line.
    Do you still have a practice? I would be more than glad to drive or fly to your office to meet with you.

    Thank you again!!!

    Christine Roder
    2 Ernies Way
    Sand Lake, N.Y. 12153


  5. Thank you so much for this article! Very informative. I just ordered my multi-vitamin & supplements you suggest. Can’t wait to see what a difference it makes. I also shared this article with my sister. I’m always struggling between choosing products for the acne but also wanting products for anti-aging! I would LOVE to be a tester for you!

  6. This really struck a chord with me. I have been on a raw food diet for a year and 8 months ago developed adult acne (I’m 27) this has caused so much stress in my life. I have ordered your Clear Skin book and cannot wait to get started!

  7. Oddly, I noticed when I was away from home for college or graduate school, my skin would clear up. Was it in the water? I don’t know. Only that I notice the same thing if I even travel out of town for the weekend. Immediately, my complexion is less red and much more vibrant. When I return home, my skin requires far more maintenance. I try to keep my diet in check but really, just the climate will even make a difference.

  8. I suffer from occasional flare-ups and found your article interesting and really appreciated the top ten listing of what to add or avoid. I will be giving them a try! Thanks

  9. Oddly, I noticed when I was away from home for college or graduate school, my skin would clear up. Was it in the water? I don’t know. Only that I notice the same thing if I even travel out of town for the weekend. Immediately, my complexion is less red and much more vibrant. When I return home, my skin requires far more maintenance. I try to keep my diet in check but really, just the climate will even make a difference.


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