The Ways in Which Stress Impacts the Skin and What to do About it

​​Stress is an unavoidable part of life, and in appropriate circumstances, it can be beneficial and even protective. However, the issue arises when stress becomes chronic. In modern society, I’ll be bold and suggest that the majority of us are chronically stressed. With never-ending to-do lists, poor work-life balance, the rising cost of living, incessant emails, constant notifications, and negative news everywhere we turn, it’s no surprise that many of us are operating in “fight or flight” mode most of the time.

Unfortunately, this stress doesn’t just affect our mental and emotional well-being but has a significant impact on our physical health as well, including the health of our skin. In this blog, we will explore the ways stress can manifest on our skin and how to reduce its harmful effects.

How Does Stress Impact the Skin?

You may already be familiar with the concept of the gut-brain axis, which describes the intricate, bidirectional communication between the gut and the brain. When the brain experiences distress, such as during times of heightened stress, it can send signals to the gut, heightening sensitivity in the gut's nerves and often triggering or exacerbating conditions like Irritable Bowel Syndrome (IBS). Equally, the gut communicates back to the brain, influencing areas related to mood and mental health, with imbalances linked to conditions such as depression and anxiety.

Similarly, we also possess what is known as the brain-skin axis, a pathway through which the brain and skin continuously communicate. A relatable example of this connection is the way our skin visibly reacts under emotional stress. Consider a moment when you felt particularly nervous or tense: perhaps your palms became sweaty, or your cheeks flushed. This is your brain signalling the skin to respond to the perceived stress.

1. Inflammation and Skin Conditions:

Stress triggers a complex cascade of responses within the body that involves the hormonal, immune, and neurological systems. When we experience stress, our bodies release various hormones, including cortisol - often termed the “stress hormone” - as well as catecholamines like adrenaline and norepinephrine, and other mediators like histamine. In cases of chronic stress, where these mediators remain elevated, the body also produces an increased amount of pro-inflammatory cytokines, which promote inflammation throughout the body.

Histamine and pro-inflammatory cytokines can lead to stress-induced hives in some individuals, mimicking an allergic reaction. While this reaction is typically acute and subsides on its own, it may recur whenever stress levels spike.

In addition to this acute response, chronic stress-induced inflammation can contribute to or worsen other skin conditions such as eczema and psoriasis. For example, a study examining the impact of COVID-19-related stress and lockdowns on psoriasis found that participants reported a notable worsening of their symptoms in direct association with increased stress levels.

One concerning link between chronic stress and skin health emerged in a study using a mouse model, where chronic stress, induced through exposure to fox urine, was shown to accelerate the development of UV-induced skin tumours. The stressed mice developed tumours much earlier than non-stressed mice, and their survival rates were significantly lower. While these findings were in animals and should be interpreted accordingly, they emphasise the importance of stress management and its potential implications for skin health.

2. Impaired Skin Barrier and Hydration:

Stress can affect the skin barrier function and impair wound healing, leaving it more susceptible to dehydration, irritation, environmental damage and infection. An impaired skin barrier is implicated in conditions like eczema and psoriasis.

Stress hormones like cortisol and adrenaline increase inflammation in the skin, damaging the skin barrier and slowing down its natural repair process. Stress also reduces the production of ceramides, which are essential lipids that help the skin retain moisture and prevent transepidermal water loss (TEWL). This leads to dry, irritated and inflamed skin. At the same time, stress weakens the skin's defences against harmful bacteria and viruses.

In one mouse study, psychological stress lowered the production of antimicrobial peptides on the skin, which worsened skin infections. These peptides are key to killing off harmful microbes, highlighting how stress can impact skin health and immunity.

3. Amplified Skin Discomfort and Pain:

Another interesting impact of stress on skin and overall health is its impact on how we perceive pain and discomfort. Stress can actually make pain feel worse, which means that pain arising from skin conditions may intensify during stressful times. Research in both animals and humans has shown that stress can alter activity in the brain’s sensory regions, influencing how pain is perceived.

In one animal study, rats exposed to chronic stress experienced reduced dopamine activity in a brain region called the nucleus accumbens, which led to heightened pain sensitivity. This reduction in dopamine, and the resulting increase in pain, persisted long after the stress ended, with dopamine activity diminished for up to two weeks and increased pain lasting nearly a month. When the stressed rats were later given morphine, they were less responsive to its pain-relieving effects than unstressed rats. This suggests that chronic stress can dampen the effectiveness of painkillers like morphine by altering the brain’s pain response system.

4. Premature Skin Ageing:

As mentioned above, stress triggers the release of cortisol and adrenaline from the adrenal glands which has been shown to impact fibroblasts - the cells responsible for collagen and elastin production. This leads to reduced collagen production, contributing to wrinkles, sagging, thinning, and fine lines.

In one study, researchers found that exposing cells to cortisol for 72-96 hours inhibited collagen production. Another study involving 25 women looked at how different types of stress affected their skin. Stress from an interview increased cortisol, adrenaline, inflammatory markers, and transepidermal water loss (TEWL). Similarly, sleep deprivation raised these same stress markers, suggesting that stress can accelerate skin ageing through hormonal and inflammatory changes.

5. Increased Oil Production and Acne

Excess sebum, our skin's natural oil, can clog pores and lead to acne. Stress is known to trigger or worsen acne, with research showing a link between acne severity and stress levels. This is because stress raises cortisol and androgen levels, such as testosterone, which increase sebum production and inflammation - both major contributors to acne. High cortisol levels have also been linked to the development of insulin resistance. Insulin resistance itself is also an independent contributor to acne.

Additionally, stress lowers ceramide production and weakens the skin barrier, making the skin more prone to dryness, irritation, and breakouts. In one study, students with acne experienced worse symptoms during exam periods, highlighting how stress can directly impact skin health.

6. Hair Loss and Hair Greying:

Stress doesn’t only affect our skin, it can also impact our hair, contributing to both hair loss and greying. The most common type of hair loss in men and women is androgenetic alopecia (male and female-pattern baldness), but stress is not a cause of this type. Instead, stress is linked to three other forms of hair loss: telogen effluvium, trichotillomania, and alopecia areata.

Telogen Effluvium: This condition involves excessive shedding of “resting” or telogen-phase hair, often triggered by stress, trauma, hormonal shifts, or certain medications. Unlike pattern baldness, telogen effluvium is reversible and typically resolves once the stressor is managed.

Trichotillomania: This condition involves a compulsive urge to pull out one’s own hair, often worsened by stress. Although multiple factors contribute to trichotillomania, stress is a known trigger that can exacerbate hair-pulling behaviour.

Alopecia Areata (AA): An autoimmune condition where the immune system attacks hair follicles, causing hair to fall out in patches. Though its exact cause is unclear, stress is thought to trigger or worsen AA. Studies show that stress-related neuropeptides like Substance P (SP) may be involved in the development of both AA and telogen effluvium. In mice, stress led to increased SP release in the brain, which induced inflammation in the hair follicles and inhibited hair growth.

Stress also contributes to hair greying through oxidative damage to melanocytes - the cells that produce hair pigment. A study in mice found that acute stress causes a release of norepinephrine, which triggers melanocyte stem cells to convert rapidly into pigment cells and leave the hair follicle. Without these stem cells, new hair grows in grey or white.

How to Reduce the Impact of Stress on the Skin?

While it may be unrealistic to eliminate stress entirely, we can take steps to reduce its impact on our skin and overall health. The goal isn’t to avoid stress but to manage it effectively. Let’s explore some evidence-based strategies to help protect our skin from the harmful effects of stress:

1. Mindfulness and Relaxation:

Incorporating mindfulness practices like meditation, deep breathing, and yoga, along with setting aside time for relaxation, helps shift the nervous system from “fight or flight” mode to a more calming “rest and digest” state. This shift can lower cortisol levels and reduce inflammation in the body.

For example, one study found that beginners in an 8-week mindfulness course experienced reduced morning cortisol levels and significant improvements in sleep. Another study showed that spending 20-30 minutes in nature could further lower cortisol, with a 21.3% per hour reduction beyond the usual daily decrease of 11.7%.

2. Move the Body:

Physical activity is a powerful way to reduce stress and boost skin health by enhancing circulation, delivering more oxygen and nutrients to the skin. Interestingly, exercise can both increase or decrease cortisol levels based on its intensity. Research shows that high-intensity exercise can temporarily raise cortisol - 60% VO2max caused a 39.9% increase, and 80% VO2max resulted in an 83.1% rise. However, low-intensity exercise (40% VO2max) actually led to a reduction in cortisol.

Although moderate to high-intensity exercise causes a temporary cortisol spike, this response has notable benefits. Experts explain that this short-lived rise can help regulate our stress response over time. One study even found that the cortisol released during intense exercise helps reduce cortisol levels in response to later psychological stressors.

3. Prioritise Sleep:

During quality, restorative sleep, the body carries out essential tissue growth and repair. Studies on sleep-deprived rats highlight this: rats with severe sleep loss developed wounds on their paws and tails, suggesting that lack of sleep can hinder healing. To support skin health, aim for 7-9 hours of quality sleep each night if possible.

Of course, this may be challenging for those who have sleep disorders and do shift work. Also stress itself can interfere with sleep, creating a vicious cycle. To counter this, try to maintain a consistent routine, even within shift cycles. Establish regular sleep and wake times, incorporate relaxation techniques before bed, and avoid stimulants like caffeine and blue light close to bedtime.

4. Gut-Health Focussed Diet:

We have what is known as the gut-brain-skin axis, a network of communication between these systems. Stress can affect both gut and skin health, worsening conditions like Irritable Bowel Syndrome (IBS) and eczema. Similarly, poor gut health has been linked to mental health issues like anxiety and depression, as well as skin concerns like rosacea. Supporting optimal gut health through diet can help enhance mental well-being and reduce stress impacts on the skin.

For instance, research on prebiotics - like the soluble fibres, fructo-oligosaccharides and galacto-oligosaccharides, found in foods such as legumes, pistachios, peas, garlic, and onions - have shown promising effects. These prebiotics reduced stress-induced cortisol release and inflammatory markers, diminished stress-induced changes to the microbiome, and altered short-chain fatty acid production in a manner that was linked with positive behavioural changes.

5. Appropriately Managing Skin Conditions:

Skin conditions can have a significant impact on an individual’s well-being, often becoming a source of stress, resulting in a vicious cycle. Effectively managing these conditions with support from healthcare professionals can help reduce the additional stress they bring. This management can also include psychotherapy methods like habit reversal and Cognitive Behavioural Therapy (CBT).

For instance, a study on psoriasis patients showed that those who completed a 6-week CBT program alongside standard medication experienced more significant improvements in symptom severity and reduced psoriasis-related stress, anxiety, and depression compared to those on medication alone, with these benefits lasting to the six month follow-up.