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Stanford University Studies

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Does Stress Cause Acne?

There has been a long debate about stress-related acne in health circles. Until a couple of years ago, the medical field was divided on the issue of whether stress causes acne, but recently there has been many clinical studies which show that stress can worsen acne.

One such study was conducted by the Stanford University School of Medicine in 2002. Although it was a small study, involving just 22 students suffering from acne, the professors involved in the study conclusively proved that the exam stress worsened acne in these students. According to researchers, their findings indicated that "Subjects who had the greatest increases in stress during examination periods also had the greatest exacerbation in acne severity."

They also noted that worsening of diet during stressful period contributed significantly in flare-ups of acne in these students.

Stress causes worsening of acne in two ways. First, by stimulating adrenal glands to produce more hormones and secondly, by slowing down the healing process.

Adrenal glands, which are located above the kidneys, secrete norepinephrine and epinephrine under stress and adrenal cortex secretes male hormones. These male hormones are well known for stimulating the sebaceous gland to secrete more sebum, which ultimately results in the formation of acne.

It has also been established that psychological stress can decrease the wound healing capacity of immune systems up to 40%. This factor doubles the impact of stress on acne.

Stress not only affects acne flare-up, in general it worsens the overall skin condition. It induces the adrenal glands into overproduction of cortisol, a steroid, which in turn makes sebaceous glands produce more oil and make skin extra oily. This the reason why in stressful periods, people experiencing an increase in acne get more inflamed, pus-filled papules than simple whiteheads or blackheads.

Another study, which was published in The Proceedings of the National Academy of Sciences (2003), found that a chemical relationship possibly existed between acne and other skin disorders and stress. This study focused the effect of stress on a particular part of the brain called the hypothalamus and detected that in stressful situations this part released a chemical called corticotropin -releasing hormone (CRH). The oil glands of skin are known to produce both CRH and CRH receptors. So, when the CRH receptors came in contact with extra CRH, it induced sebum production by oil glands which ultimately resulted in exacerbation of acne.

Acne urticata is related to stress, although not clearly how. Actually it is a form of eczema and not acne, which is found mostly in middle age women who suffer from stress and depression. It's not clear whether the acne is caused by stress, or the stress is resultant of acne urticata.

A German dermatologist, Dr Jerome Litt, has written a book about skin in which he has expressed firm belief that stress does aggravates acne. He believes that stressful situations increase the production of male hormone testosterone and androgens. These hormones are also instrumental in extra sebum production which causes acne. According to Dr. Litt, acne patients should avoid "SWAT"- that is Stress, Worry, Anxiety, Tension- as these increase acne.

Stress may be positive, like getting married or arranging an important function, or negative like some tense situation at work place. Both positive and negative stresses have the same impact on body chemistry, increasing the male hormone production in body. In both situations people face worsening of acne.

Believing that stress is directly linked to the worsening of acne, it might be helpful to develop techniques for bringing down the stress level in people suffering from acne and help them control their acne. Some groups, including NASA, have taken an unusual approach in their effort to find ways of reducing stress and thus help some common conditions like acne, high blood pressure, asthma etc.

Other Resources: P.M.E. Catherine Atzen NZ Dermatological Society Alan Green, Md

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