SDSS News on Skin Care

Credits: Deblina Chatterjee

A nutritious diet is one of the major factors for healthy and problem-free skin. These signs help to understand if your diet is destroying the skin quality. 
 

According to doctors, healthy skin also depends on a healthy diet. If your diet is not filled with all important nutrients then it will harm your skin quality and start to damage it. As a result, there will be skin issues that you will have to deal with.

But if your diet is affecting your skin, then it will show some subtle signs which need to be noticed. If you can spot the signs and change your diet, the damage can be prevented to an extent. So, here are the signs to understand if your diet is ruining your skin quality.

Signs your diet is not good for your skin:

Fine lines and wrinkles

This generally is caused due to excessive alcohol and sugar consumption. Alcohol makes you dehydrated and takes out all the moisture from the skin making it dull and lifeless. As a result, you get fine lines and wrinkles.

Breakouts

If you are having too many breakouts or acne on your skin, then you need to blame the high-glycemic foods like white bread, bagel, sandwich bread, etc. They all affect the levels of your blood sugar and insulin leading to acne problem.

Dark circles

The reason for dark circles is an insufficient intake of water. Your skin is getting dehydrated due to less water consumption and thus causes dark circles around the eyes. So, increase water intake daily to deal with this issue.

Dry skin

If you have too much salt in your diet, then that’s causing the dry skin problem because our body overcompensates the sodium by holding onto water. So, limit your salt intake.

Oily skin

Oily skin is caused by the excessive consumption of dairy products like milk. People having skimmed milk can also have severe acne issue and oily skin. So, limit your dairy intake for some days to spot changes.

Bumps and irritation on the skin caused by yeast overgrowth

 
Fungal acne, also known as pityrosporum folliculitis or malassezia folliculitis, is caused by an overgrowth of yeast in the hair follicle, leading to breakouts, itching, and irritation on the skin’s surface. It can be quite distressing due to its discomfort and cosmetic concerns. It’s treated differently than other types of acne. It can often be controlled or prevented. 
 
Symptoms

Fungal acne, also referred to as fungal folliculitis, occurs when yeast enters the hair follicle and multiplies, causing acne-like breakouts on the skin’s surface. The tiny round papules are often pink and occasionally have a whitehead. Yeast is a type of fungus, and that’s why this skin condition is called fungal acne.

Fungal acne is usually accompanied by the following: 

  • Swelling and redness
  • Irritation of the hair follicle
  • Itching
  • Acne-like breakouts 
  • Occasional stinging sensation2

Fungal Acne vs. Acne Vulgaris

Fungal acne is often confused with acne vulgaris because they look similar. Vulgaris is the medical term for “common,” and it’s used in “acne vulgaris” to distinguish it from other types of acne.3

The causes, symptoms, and treatments of fungal acne and acne vulgaris are different, however:

Fungal Acne
  • Caused by a yeast infection in the hair follicle

  • Most common on the upper back and chest

  • Breakouts are pinhead-sized and uniform

  • Does not improve (or even worsens) with antibiotics

  • Intense itching

Acne Vulgaris
  • Caused by oil and bacteria clogging the pores

  • Most common on the face, neck, and chest

  • Breakouts usually have blackheads or whiteheads

  • Sometimes treated with antibiotics

  • Does not cause itching

 

Causes

Malassezia, a type of yeast, is common on the skin. It usually doesn’t cause any skin problems, but under specific conditions, it can lead to infection and irritation in the form of fungal acne. 

While doctors do not fully understand what causes the yeast to invade hair follicles, it’s known that yeast multiplies quickly in hot, sweaty places. Individuals who live in hot, humid climates are therefore more likely to experience fungal acne.

Wearing clothing that does not breathe well, such as synthetic fabrics, and sweaty clothing for too long or re-wearing workout gear can make you more likely to develop fungal acne as well, so is wearing tight or restrictive clothing.

This type of yeast feeds off of skin oil, also known as sebum. Having oily skin or adding extra oil to your skin in the form of sunscreen or lotion can put you at higher risk of fungal acne. Adolescents are therefore more likely to be diagnosed with fungal acne because hormonal changes during puberty can increase sebum production in the body. Men are more susceptible to fungal acne than women.

Medications

While uncommon, certain medications can put you at higher risk for developing fungal acne. Oral antibiotics, sometimes prescribed for common acne, can make fungal acne worse because the antibiotic reduces your skin’s good bacteria, which help to regulate the amount of yeast on your skin. Without the good bacteria to balance it out, yeast can multiply quickly.

Oral steroids like prednisone dampen your body’s immune response, which means you won’t be able to control yeast overgrowth as effectively. For women, oral contraceptives can increase the level of estrogen in the body, which affects skin oil production, making them more susceptible to yeast overgrowth.

Underlying Conditions

Any medical condition that causes immunosuppression like HIV infection could put you at higher risk of fungal acne because your body is unable to control yeast overgrowth. If you are immunocompromised and start to notice red, itchy bumps, consult your doctor. 

How to Prevent Fungal Acne

The best way to prevent fungal acne is to avoid conditions that help yeast grow. Yeast needs hot, humid conditions to thrive, so be sure to wear breathable fabric on your skin, especially when working out. Once you finish exercising, shower and dry off right away. Yeast also loves feeding off of carbohydrates, so limiting sugar in your diet could help to prevent overgrowth. 

If you have a history of fungal acne, washing the affected area with an anti-dandruff shampoo in the shower could help to prevent yeast overgrowth.5 

Diagnosis

Usually your dermatologist will be able to diagnose fungal acne after a brief physical exam. They will look for uniform, pinhead-sized red pustules on the hair follicles on the upper chest and back. Bumps caused by yeast are typically of the same size, and whiteheads are generally not seen with fungal acne.

Your dermatologist may ask you a few questions during the exam, such as:

  • How long have you been experiencing these bumps?
  • Are they itchy?
  • Do they seem to get worse in the heat?
  • Have you started any new medications lately?

They may recommend doing a skin scraping to look at your skin cells under a microscope and detect the yeast responsible for fungal acne. This method is not always definitive because most people normally have this yeast on their skin. A Wood’s lamp exam, which involves using ultraviolet light to look at the skin closely, may also be performed. If you have fungal acne, a yellow-green fluorescence will be seen.

Fungal Acne Is Commonly Misdiagnosed

Fungal acne is commonly misdiagnosed as common acne. Differentiating the two is important since antibiotic treatment may make the problem worse. When left untreated, fungal acne may persist for many years. This condition should be considered especially in people who fail to respond to typical acne medications, have itchy skin, and bumps of around the same size.

Treatment

Treatment for fungal acne has two goals: to treat the yeast overgrowth and to address the underlying cause. If the yeast overgrowth alone is treated, the fungal acne will most likely recur.

Fungal acne is often treated with both antifungals and acne medications.

Oral Treatment

Oral treatment is usually the most effective option, especially for controlling the initial symptoms. The two most common oral antifungal medications prescribed are Nizoral (ketoconazole) and Sporanox (itraconazole). For tough-to-treat cases, Accutane may be considered.

The length of treatment depends on how widespread the fungal acne is and how it is responding to the medication. Once the outbreaks and itching are under control, your doctor will help you develop a plan to slowly wean off of the antifungal medications. This process can take months.

Adverse Side Effects

While oral antifungals are highly effective at treating fungal acne, it’s important to weigh their benefits with the potential adverse side effects. The most common side effects include:

If you are experiencing any of these side effects from your fungal acne treatment, talk with your doctor about the next steps. 

Topical Treatments 

While oral treatments are more effective, topical ones can be helpful for maintenance and even prevention of future episodes of fungal folliculitis. Topical treatments usually come in the form of an anti-dandruff shampoo and are to be used every day for a week. The most common treatments are Nizoral or Selsun. They can be applied in the shower and left on for 10 minutes before rinsing off.

Your doctor may also prescribe 50% propylene glycol in water to be used twice daily for three weeks or the Lamisil (terbinafine hydrochloride) antifungal spray for two weeks.

Prognosis

Studies show that fungal acne is very treatable. However, it does have a high incidence of recurrence.5 Once your fungal folliculitis has been treated and is completely gone, talk with your doctor about preventive measures you can take to keep your skin clear and healthy. For those who are prone to fungal acne, periodic re-evaluation of predisposing factors is recommended. 

Coping

Because fungal acne is caused by yeast entering the hair follicle, you can help prevent it by keeping your skin as clean as possible. Wash your skin daily and try not to shave every day since this could be irritating to the hair follicle. Other preventive measures involve removing the conditions in which yeast thrive, such as wearing breathable fabric that wicks away sweat when you exercise or spend time outdoors. Don’t re-wear sweaty fitness gear, and avoid oily lotions and creams since yeast feeds off of excess skin oils.

If you’re concerned that your fungal folliculitis is returning, see your doctor right away. The sooner you catch it, the easier it is to treat.7 

Word From Verywell

While the irritation and appearance of fungal acne can be bothersome, the cause is usually easily treated and even preventable with a regular skin care routine and avoiding skin care products that will lead to excess sebum. It’s important to note that fungal folliculitis will not respond to typical acne medication, and the use of these drugs may make it worse. If you suspect you have fungal acne, talk with your dermatologist or primary doctor about what to do.

Credits: Colby Stong

Daily use of moisturizers, cleansers, and sunscreens can reduce inflammatory and noninflammatory acne lesions and may be helpful for acne treatment if combined with specific medications, researchers reported in Dermatologic Therapy.

The investigators conducted a literature review with the goal of highlighting the importance of choosing the right topical dermocosmetics for different skin types and the most effective method of combining dermocosmetics with the standard acne treatment.

“The basic therapeutic strategy for acne care is the control of sebum secretion, abnormal keratinization of follicular epithelium, and bacterial infection,” stated the study authors. “Therefore, anti-inflammatory drugs, bactericidal medications, and agents aimed at controlling keratinization are mainly used for acne care. Modern therapy of acne is based not only on the use of specific drugs, but also on ‘complementary’ products, such as moisturizers, cleansers, and sunscreens.”

Patients with oily skin should use a highly rinsable product with no residual moisturizer. These products include those based on sodium lauryl sulfate, according to the researchers. They recommend that patients with dry skin or skin damaged by the sun or smoke use a non-comedogenic moisturizing liquid cleanser.

Daily facial cleansing is important for acne care and should be done twice a day, and use of aggressive and strong surfactants should be avoided because of their strongly alkaline pH, according to the investigators. Available cleansing options include cleansing milk, cold cream, cleansing oils, cleansing balms, micellar water cleansers, non-foaming cleansers, and foaming cleansers.

Sun exposure affects progression of acne, because it can promote bacterial proliferation and reduce immune response, leading to inflammation. “Therefore, it is essential to explain the importance of sun protection to the patient,” noted the study authors. “In this regard, light and nonocclusive products, in the form of sprays, gels, or liquids, should be preferred.”

Makeup may provide quick results for covering acne, but it should be removed at night, and cosmetics such as colored creams and concealers should be oil-free and noncomedogenic, advised the researchers. Sonic cleansing supports are increasingly used for daily care such as removing makeup or sunscreens, and cleansing with the sonic brush may be beneficial for inflammatory skin conditions.

Treatment for patients with acne should include education about proper daily skin hygiene, including protection from environmental damage, according to the study authors.

“Cleansers should stay on the skin as briefly as possible to minimize damage to the stratum corneum proteins,” the researchers recommended. “However, this brief contact does not allow the various components of the cleansers to penetrate and remain in the skin. A solution may be to carry out a double cleansing, first with an oil-based cleanser, then with a water-based or surfactant-based cleanser. It is used to easily remove makeup, impurities, and oily residues, allowing the detergent to penetrate deeper, for a better level of cleansing.”

Credits:  Mary Scoviak

Dermatology Times
 

Recent literature shows associations between rosacea and numerous inflammatory gastrointestinal disorders.

Therapies targeting in­flammatory gastrointestinal (GI) disorders may play a future role in addressing immune system dysregulation and the rosacea symptoms that arise from it, according to a recent systematic review published in Dermatologic Therapy.1 The article, which reviewed literature based on the associations between rosacea, skin and gut disorders, and GI disorders suggests future studies should focus on specific mechanisms linking GI pathology with rosacea manifestations and the role of enteral drugs in mitigating cutaneous symptoms.

“Current theories highlight the role of the cutaneous microbiome, specifically D. folliculorum and a few commensal bacteria, in the propagation of an in­flammatory response and its associated in­flammatory effects in rosacea’s pathogenesis,” wrote first author Hala Daou, MS IV, University of South Florida Morsani College of Medicine.

In their review of the literature in PubMed, Cochrane, and Embase from their inception to August 6, 2020 (154 of the 708 papers gathered from database searches received full text review), the authors considered articles on current theories implicating immunity dysregulation, aberrant neurovascular signaling, chronic in­flammation and overgrowth of commensal skin organisms, as well as associations with additional GI pathologies, including small intestinal bacterial overgrowth (SIBO), irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) and Helicobacter pylori (H. pylori) infection.

Also of interest were results on the generation of reactive oxygen species (ROS) due to an altered innate immune response that, according to Daou, “appears to be a component of rosacea’s mechanism of disease. Studies demonstrated higher levels of ROS in patients with this condition.”

Studies in the review discuss:

The cutaneous membrane: Skin affected by rosacea has significantly more expression of cathelicidin than normal skin, which may result in aberrant downstream effects and may also represent a link between rosacea and IBD.

Demodex folliculorum (D. folliculorum): A study notes an association between D. folliculorum and in­flammatory markers, “suggesting a deleterious activation of the immune system.” The cytokines observed (including interleukin (IL)-8 and tumor necrosis factor alpha (TNFa)) promote angiogenesis, highlighting a potential cause of the long-standing, prominent telangiectasias often present in rosacea.

Bacillus oleronius: This microorganism produces antigenic proteins that potentially play a role in papulopustular rosacea (PPR), erythematotelangiectatic rosacea (ETR) and ocular rosacea.

Staphylococcus epidermidis: The altered microenvironment of rosacea-affected skin could potentiate exacerbation of symptoms due to a shift in micro­flora.

The gut microbiome: One case study shows a significant association between rosacea and a variety of systemic disorders including allergies, respiratory disease, GI disorders, hypertension, urogenital disease, and female hormonal imbalance, while a later population-based cohort study of 50,000 Danish patients with rosacea shows the prevalence of celiac disease (CeD), Crohn’s disease (CD), ulcerative colitis (UC), small intestinal bacterial overgrowth (SIBO), and irritable bowel syndrome (IBS) were all significantly higher among patients with rosacea compared to controls.

IBD: Increased risk of rosacea in patients with UC and CD is almost threefold compared to patients without IBD. A shared autoimmune susceptibility may provide a link between rosacea and GI disorders.

H. pylori: A theorized association describes H. pylori in­flammation via cytotoxins and gastrin-induced ­flushing. There is speculation that systemic effects may be due to increased mucosal permeability to alimentary antigens, an autoimmune mechanism via the production of cross-reactive antibodies, or the impairment of vascular integrity.

SIBO: Patients with rosacea are 13 times more likely to have SIBO than controls.

Current studies are investigating erenumab, a human monoclonal antibody that antagonizes the calcitonin gene-related peptide receptor (CGRPR); timolol, a nonselective b-adrenergic antagonist and rifaximin, a semisynthetic nonsystemic antibiotic that acts as an intraluminal agent. Pulsed dye laser treatment with oxymetazoline hydrochloride 1% cream for the treatment of the ETR subtype is also being studied. “The results of these studies will be formative in the future rosacea treatment arsenal,” wrote Daou.

Disclosures: The authors report no relevant disclosures.

References:

1 Daou H, Seminario-Vidal L, Hennessy K, Paradiso M. Rosacea and the microbiome: a systematic review. Dermatol Ther. 2020.Available at: https://www.semanticscholar.org/paper/Rosacea-and-the-Microbiome%3A-A-Systematic-Review-Daou-Paradiso/c1aa397be0654eb3a63161027b29f2917d563719. Accessed November 13, 2020.

This Is Your Skin on Stress

Psychological strain can show up as “stress skin.” Treating it is easier (and more affordable) than you think.

It starts in utero.

A mass of cells divides and develops, splits and stretches, and from a single layer of embryonic tissue, two seemingly separate but inherently interconnected systems are born: the brain and the skin.

They are bound for life. When one senses embarrassment, the other blushes. When one senses pain, the other processes it. And when one bears the burden of a pandemic, political unrest, systemic racism and the ever worsening effects of climate change … well, the other gets a pimple.

Or perhaps, depending on your genetic predispositions, it’s not a pimple but an eczema outbreak. A psoriasis flare-up. A bout of rosacea. A dehydrated, dull, oily or even — gasp — older-looking appearance. General blahness, if you will.

This is your skin on stress.

“There are two different types of stress: acute stress and chronic stress,” said Dr. Whitney Bowe, a dermatologist and the author of “The Beauty of Dirty Skin.” A quick surge of stress can be a good thing. It may heighten your senses, enhance mental clarity and help create collagen to facilitate wound repair.

 It’s there and it’s gone.

It’s the chronic, continuing stress, the kind that every sentient being is likely experiencing right now, that takes a toll on the skin.

 

It takes a toll on the entire being, of course, and a compromised complexion is the least of its consequences. But “the skin is the organ that we see,” as Dr. Loretta Ciraldo, a dermatologist and founder of the Dr Loretta skin-care line, put it. And in a society where unsustainable stress is not only the norm, but sometimes a celebrated sign of success, what better way for the subconscious to cry out than “stress skin”? (It is, after all, easier to ignore your feelings than your face.)

 

 

Here’s How Stress Affects Your Skin

Much of the skin-psyche connection comes down to the overproduction of cortisol, the primary stress hormone, and its effect on the skin barrier.

“The barrier traps moisture in and keeps allergens, irritants and pollutants out,” Dr. Bowe said. It effectively does the job of most skin-care products on the market, sans products, and needs three things in order to thrive: oil, water and the microbiome. Cortisol depletes them all.

During times of stress, cortisol slows the production of beneficial oils. “We get dry, rough and much more irritated because those healthy oils act as a protective layer for us,” Dr. Ciraldo said. Without adequate lipids to seal in hydration, the skin starts to “leak” water in a process known as transepidermal water loss (TEWL).  

At the same time, cortisol stimulates the overproduction of sebum, the oil that is implicated in acne. “So for many of us, our skin seems more oily when we’re under stress, and it’s more acne prone,” she said.

All of this alters the skin’s pH, which compromises the acid mantle and creates an inhospitable environment for the one trillion symbiotic micro-organisms that exist on and in the skin barrier — a.k.a., the microbiome.

Under ideal conditions, the microbiome renders topical skin care all but superfluous. There are microbes that feed off sebum, which helps sustain healthy oil levels. There are microbes that feed off dead skin cells — the original exfoliators! There are microbes that produce peptides and ceramides, two buzzed-about beauty ingredients that keep skin firm and moisturized. There are microbes that offer protection from pollution, sunlight and invading pathogens.

“If you’re not producing enough of those healthy fats and not maintaining a healthy barrier, though, you’re altering the terrain on which these microbes grow and thrive,” Dr. Bowe said. “Imagine stripping the soil of all the nutrients and seeing if your vegetable garden is going to grow. It’s the same for the skin.”

In turn, the microbiome may experience an overgrowth of so-called bad bacteria (like C. acnes, the strain associated with acne) and a dearth of good bacteria. The microbiome becomes more prone to infection, irritation, inflammation and hyperpigmentation. It becomes more sensitive to outside aggressors, like the free radicals generated by pollution.

Stress prompts the body to produce internal free radicals, as well. “You can think of free radicals like little missiles,” Dr. Bowe said, in that they target cells for destruction and cause oxidative stress. When free radicals target DNA, it leads to skin cancer. When free radicals target elastin and collagen, it leads to fine lines and wrinkles. When free radicals target lipids, it leads to dehydration and skin barrier damage and acne.

Credits:Jessica DeFino
 
Vitamin F is not a real vitamin. It’s not even one single nutrient. I would say it’s almost like a vitamin complex, similar to vitamin B — what with all its B3s and B5s and B12s — but that’s not quite right, either. 
“‘Vitamin F,’ in short, stands for fat,”
“In terms of skincare, this name is sometimes used to refer to two essential fatty acids (EFA): linoleic acid (LA), an Omega-6 EFA and alpha-linolenic acid (ALA), an Omega-3 EFA.”
 
That sentence and its arrangement of abbreviations is admittedly a little confusing, so I’ll try to break it down: Vitamin F is the term used to describe the combination of two different types of essential fatty acids, linoleic acid and alpha-linolenic acid. To make things more confusing, both of those fatty acids go by different names. Linoleic acid is also referred to as an Omega-6 fatty acid, and alpha-linolenic acid is also referred to as an Omega-3 fatty acid. 
“LA and ALA are classified as essential fatty acids, which means our body cannot produce these fatty acids on their own,” she says. However, “They are necessary for maintaining regular functions in our body, including brain, heart, hormone, immune, and skin health, amongst others. We [must] obtain our requirements through outside sources.” Yup, you read that correctly: Your body needs LA and ALA (together, vitamin F) to function properly — hence, why they’re called “essential” — but can’t produce them alone. Technically, humans can get all the vitamin F they need through diet, but there is another way: topical vitamin F. 
 
 “Both LA and ALA affect immune responses and inflammation in our body; and because LA and ALA play a big role in our cell membranes and immune health, they play a big role in our skin.” The role can be summed up in two words: barrier integrity.

“In order to stay hydrated, the skin needs a mechanism to trap water inside the skin layers, preventing it from evaporating from the cells,” Dr. Nava Greenfield, M.D., F.A.A.D., a dermatologist with Schweiger Dermatology Group in New York City, explains in an email to TZR. “Fatty acids are important components of the many skin layers to maintain its barrier function: maintaining water retention, keeping essential nutrients inside, and environmental toxins outside.” In other words, vitamin F helps lock moisture in, keep toxins and bacteria out, heal existing damage, and prevent “dryness, rough texture, increased sensitivity, allergies, inflammation, aging, and skin conditions like rosacea, acne, eczema, and atopic dermatitis.” That is basically every skin condition known to man, so yeah, vitamin F is pretty important.

Both dermatologists agree that ingestible and topical versions of vitamin F will keep skin hydrated, healthy, and glowing. “Shellfish, seaweed oil, flaxseed, olive oil, canola oil, chia seeds, sunflower seeds, walnuts, and leafy vegetables are high in vitamin F,” 

 Sunflower, safflower, evening primrose, rosehip seed, flax seed, cranberry seed, avocado, olive, and hemp seed oils are all great sources of vitamin F. You can even “DIY” vitamin F skincare by mixing a face oil that’s high in Omega-3 (grape seed oil, poppy seed oil, castor oil) with one that’s high in Omega-6 (pumpkin seed oil, chia seed oil).

Bonus: “They can also help with the strength and shine in hair,” Dr. Turegano. All I have to say is: F, yeah.

Dermatologists weigh in on the effects stress can have on your skin — and what to do about it.
Credits: Rebecca Dancer
 
At this point, it is not an exaggeration to say that we are all living in a time of unprecedented stress. While the global coronavirus pandemic continues to evolve and our collective feelings of uncertainty about the future continue to mount, it’s easy to feel helpless. Which is why we’d argue that now, more than ever.

Of course, stress manifests itself in many ways and everyone experiences it differently, but for the purpose of this story, we’re talking about stress acne. Not the stress-induced pimple that pops up right before a big test in school or presentation at work. Rather, the kind of impact that long-term feelings of underlying stress, coupled with universal uncertainty in the world, can have on our skin.

 

“The relationship between psychological stress and the physical appearance of skin is affected by complex interactions across the body,” explains Evan Rieder, a board-certified physician who specializes in both psychiatry and dermatology in New York City. In short: “Stress can cause many skin conditions to worsen,” he says.

 

For more information on the link between stress and breakouts, plus some of the best ways to deal with, treat and prevent stress acne, we tapped a pool of skin and psychiatric experts. Here’s what they had to say.

Why do feelings of stress show up on our skin?

“First of all, stress never makes anything better, and lots of skin conditions including eczema, psoriasis, and acne can flare with stress,” explains Shari Marchbein, a board-certified dermatologist in New York City. (A study from Stanford University School of Medicine found that increased acne severity was “significantly associated” with higher stress levels.) “Pimples, whether large cystic lesion or small comedones, are caused by a combination of four things.”

 

Those four things include bacteria (called c. acnes), general inflammation, plugged-up pores, and hormones — which is the key factor associated with stress-induced acne. Specifically, a hormone called cortisol, “which increases in the blood at times of stress or with lack of sleep,” is responsible for triggering breakouts, Marchbein explains.

The level of stress that prompts a flare-up can vary from person to person, and you may notice your skin changing just a few hours after a stressful event, says Laurel Naversen Geraghty, a board-certified dermatologist in Medford, Oregon. Even before your mind registers anxiety, those feelings may manifest on your skin.

“Your body reacts to stress by elevating certain hormones, such as cortisol, to put it in a state of ‘fight or flight,’” explains Janelle Vega, a board-certified dermatologist in Coral Gables, Florida. “The oil glands in the skin actually have receptors for this hormone, so an increase in stress will increase the formation of oil in the skin.”

But that’s not all — acne is also largely influenced by general inflammation, and stress messes with that, too, specifically by directly increasing “inflammatory mediators” in the skin cells, Vega explains. Moreover, feelings of stress have a general depressive effect on the body’s immune system, which “may make your acne worse by lowering your body’s ability to fight inflammation,” explains Sandra Lee, a board-certified dermatologist based in Los Angeles. (You may also know her as Dr. Pimple Popper.)

Additionally, feelings of stress can even cause us to treat our skin differently from the outside, in. For some people (myself included), when the outside world feels too stressful to bear, for too long a period of time, we might neglect our normal skin-care routines — or forgo it altogether. For others, stress can manifest in touching the skin more frequently or aggressively.

“Acne is exacerbated by picking [the skin], and picking is usually stress-triggered,” Lee explains. “Oftentimes we pick at our skin and don’t even realize we are doing it [because] we are deep in thought stressing about something else.”

Not only will picking the skin exacerbate existing breakouts, but it also carries “a definite risk of causing permanent scarring,” Lee explains. “So it’s important to stop doing this, but it’s difficult because it’s often closely related to stress.”

For all of these reasons, stress-induced breakouts manifest in many different forms, so it’s “impossible to generalize” about exactly how it will present itself (i.e. as blackheads or pustules or cysts), Marchbein explains, though she does note that cystic acne is “especially common with stress.”

How to cope with — and tame — stress breakouts

“Keeping routines can be profoundly helpful in times of unprecedented stress and uncertainty,” Rieder says. “When we have seemingly lost control of [many of] the elements that give us peace, including our occupations, finances, and health, normalcy in any sense is welcome [and] things that we take for granted and often do automatically are important to maintain.”

Perhaps number one on this list is sleep — both getting enough of it and also trying to stick to regular sleep-wake hours. Sleep is crucial to our health for many, many reasons, however, as pertaining to overall skin health, the importance of getting your Zzz’s ties back to cortisol. This is because when we’re sleep-deprived, our bodies produce an increased amount of cortisol, which, as previously established, can spiral our skin out of balance.

 

Next on the list of important routines to maintain is “eating regular meals [and] having dedicated time both to yourself and for socializing, exercising, and practicing self-care in the way that you best respond to,” Rieder explains. In terms of self-care, he personally recommends activities like meditation, yoga, deep breathing, exercise, and skin care, but the entire idea here is to take the time — regularly — to take care of yourself in a way that feels good to you.

It’s also worth noting that one factor that can be both a source of self-care and stress is technology. While streaming an online exercise class is a highly recommended form of self-care among all the experts we spoke to, spending too much time on your phone or computer is not — especially when it feels like terrifying news updates pour in on an hourly basis. Still, it’s also important to stay informed.

Again here, it’s about striking a balance that feels right to you and prioritizes your mental health. Rieder’s recommendation: “Find one or two news sources that are trustworthy and spend no more than 30 minutes daily informing yourself,” he says.

“It is easy to get attached to your only source to the outside world — your phone and television — during a time like this,” Vega agrees. “While it is good to be connected, you also need to detox from the overwhelming stress of the world in general.”

The best topical treatments to treat stress acne

When it does spring up, stress pimples respond best to a few specific topicals: salicylic acid, benzoyl peroxide, and retinol, Marchbein and Vega explain. Each ingredient works in different ways to combat breakouts. Salicylic acid can unclog pores, benzoyl peroxide is anti-inflammatory and antibacterial, and retinol increases skin cell turnover rate.

That doesn’t mean that you should use all three at once, however. Instead, Vega recommends using retinol as a long-term solution, and keeping either a salicylic acid or benzoyl peroxide product in your medicine cabinet to use as a spot treatment as needed.

Pimple Blemish spot treatment can also be used as a spot treatment for acne.

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