From sudden breakouts to puffy eyes and mystery flare-ups, stress leaves a calling card all across your face. When your system is sounding the alarm and saying, “I’m giving it all she’s got, cap’n,” your skin often responds with a massive freakout, just when that’s the last thing you need. The good news is that your dermatologist can interpret that SOS and help your skin, as well as the rest of you, get back on the right track.
“When we’re under chronic stress, the body activates the hypothalamic-pituitary-adrenal axis — that’s our internal stress response system — which triggers the release of cortisol, hormones and neurotransmitters like catecholamines and neuropeptides like substance P, which is a neurotransmitter in the nervous system,” explained dermatologist Dr. Hallie McDonald. “The release of these stress mediators has multiple effects, and they can increase inflammation and itching, impair the skin’s barrier and wound healing and can even suppress local immunity.”
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Flare-ups of any skin condition are a common response to stress.
If you’ve had some skin issues lately, here are the top ones that often have a stress component, according to dermatologists. These experts provided recommendations on regaining healthy skin and managing stress.
Acne: “The most frequent dermatologic manifestation of stress I encounter is stress-induced acne,” McDonald said. “Stress hormones like cortisol increase oil production and inflammation, which can make breakouts and irritation worse.”
Flare-ups of eczema, psoriasis or rosacea: “Many conditions like eczema and psoriasis flare during stress, so I often will see worsening of these,” said dermatologist Dr. Aleta Simmons.
Undereye bags: “I see stress reflected in the under-eye area,” McDonald said. “Elevated cortisol promotes sodium and water retention, and when that’s paired with disrupted sleep, it can lead to puffiness. That’s a subtle but very real sign that the body, including the skin, is feeling the effects of stress.”
Undereye darkness: “Dark circles around the eyes can be a sign of lack of sleep,” Simmons said. “We know that stress plays a role in sleep disturbances, so it’s important for me to figure out if the dermatologic condition, stress or a combination of the two is leading to sleep changes.”
Texture: “A rougher skin texture also may appear, because stressed skin is often more reactive to products and environmental changes,” said dermatologist Dr. Lauren Moy.
Hair shedding and thinning: “Another sign we look for is hair shedding, also called telogen effluvium, which can occur several weeks to months after a major stressor,” McDonald said. “Patients will tell me that their hair is ‘falling out at the root.’ This could be caused by stress alone, but it can also be triggered by illness, surgery, childbirth, nutritional deficiencies or hormonal changes.” Moy agreed, adding that shedding isn’t the only way hair can respond. “Stress can affect the hair’s texture as well as its density,” she said.
Hives: “Flare-ups of any skin condition are a common reaction,” said dermatologist Dr. Aamna Adel. “I tend to see hives a lot, which are very much linked to the stress response.”
Picking: “Skin picking, nail biting and cuticle picking are incredibly common and can be strong indicators that someone is under more stress than usual,” McDonald said. “These repetitive behaviors can cause scabs, small wounds or ragged nails. Over time, this can lead to scarring, hyperpigmentation or recurrent wounds that don’t heal properly because the skin barrier is constantly being disrupted.”
Increased sensitivity: “Patients often tell me, ‘My usual moisturizer now burns,’ or ‘Everything I put on stings,’” McDonald said. “It’s not that the products changed, but their skin’s threshold did. The nerve endings and skin barrier are simply more sensitized from stress reactions.”
What to do now
If your skin has suddenly started reacting to the stress around you, the first thing to do is … relax. As hard as it is to avoid, McDonald says it’s important not to rush to throw every “miracle” treatment in the world onto your already struggling epidermis.
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“One of the most important messages to get across is that stress-related skin changes are incredibly common, and they are also reversible,” said Dr. Hallie McDonald.
“Understandably, patients often reach for quick fixes or start switching products rapidly in an effort to get things under control,” she said. “Unfortunately, that approach tends to backfire. When the skin barrier is already compromised, too many new ingredients or harsh treatments can make inflammation and sensitivity even worse.”
Instead, she takes a much gentler approach. “My first step is to help patients calm and rebuild their skin barrier,” she said. “I recommend going back to basics like gentle cleansers, fragrance-free moisturizers and mineral sunscreens. A consistent, simplified routine does far more for stressed skin than constantly chasing a new product or trend.”
It’s not all about new prescriptions, either, said dermatologist Dr. Tomi Lee Wall. “I emphasize to my patients that simply applying a new cream or taking a medication without addressing the underlying issues won’t resolve their condition,” she said. “In medicine, there is definitely a mind-body connection that can’t be ignored.”
Calming yourself (and your skin)
If you know that stress is affecting your skin, what can you expect to discuss at your next dermatologist appointment? Moy said: “When I talk about stress with patients, I often explain that the skin is often a reflection of what’s happening inside the body. I remind them that stress, sleep, diet and hormones all play a role in the skin’s overall health.
“I typically ask about their daily routines, sleep schedule, work and any stressors they may be under. I help patients build a proper skincare regimen to address their skin concerns and discuss the importance of a consistent sleep schedule and healthy diet and lifestyle. The goal is always to empower patients to see the connection between their lifestyle and skin health, while providing tangible solutions.”
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McDonald added, “One of the most important messages to get across is that stress-related skin changes are incredibly common, and they are also reversible. The skin is part of the body’s stress response system, and when we regulate that system, the skin benefits. I remind patients that their skin is resilient, and sometimes the best ‘treatment’ for their skin is giving themselves permission to slow down and take care of their overall well-being.”