Stress Acne in Brown and Black Skin: What You Need to Know
Written by: Beatrice Maina
Acne and stress have a connection, period.
Darker skin tones are significantly affected by acne due to the post-inflammatory hyperpigmentation or acne scars that are left behind (long after your breakout is gone). People of African heritage, Hispanics, Indians, and Asians belong to the dark-skinned group whose acne scars or dark marks can take years to fade. And dealing with breakouts and scars from stress acne can dampen your spirits and can turn confidence into low self-esteem.
Typically, acne results from hormonal changes or genetics. But the focus of this article is stress acne. There’s increasing evidence that emotional stress is among the factors that lead to acne progression.
A study in the National Library of Medicine shows a link between emotional stress and extreme acne. Two more Korean epidemiological studies showed that most participants reported emotional stress as the main trigger of acne. A study by KSA Scholar reveals that people with increased stress levels experience severe acne.
So, what is stress acne and how do you manage it? This is best left to an expert, so we spoke to Dr. Shakirat Gold-Olufadi, a dermatologist with experience in treating skin of color, and here’s what she had to say.
Consultant Physician, Dermatologist (MBBS, MWACP, FMCP) and runs the blog, Skinandall.
Dr. Shakirat is a consultant at the University College Hospital in Ibadan, Oyo State, Nigeria. She possesses expert training in clinical and general dermatology. She is a member of the Nigerian Association of Dermatologists (NAD), International Society of Dermatology (ISD) and has received scholarships from the American Academy of Dermatology (AAD) and the World Congress of Dermatology (WCD)
She had her residency training at Lagos University Teaching Hospital and the diversity of patients seen in Lagos as the commercial hub of Nigeria exposed her to a wide range of dermatological conditions with expertise on how to manage these conditions. Her proficiency also extends to aesthetic dermatology, cryotherapy and dermatologic surgery. Her interest in procedural dermatology afforded her the opportunity to get a hands-on mentoring scholarship in dermatologic surgery through the ISD in Brazil under the able tutelage of Dr. Luiz G.M. Castro, a prominent dermatologic surgeon in Sao Paulo.
What Is Stress Acne?
Yes, the name says it all: it's acne caused by stress. We wanted to dig deeper to understand the connection between stress and acne.
Gold-Olufadi explains that stress acne “refers to acne where stress is contributing to its cause. It is usually more of an aggravating factor than a true cause. The stress may be in the form of physical stress such as poor sleep from deadlines to meet at work, or emotional stress such as going through a relationship breakup.”
So considering that stress can aggravate acne, let’s look at the other factors that usually contribute to acne in brown skin. Gold-Olufadi says, “Several factors contribute to acne normally, which include increased sebum production on the areas rich in sebum, follicular plugging [this is when keratin blocks hair follicles and the distended follicles burst and expose the dermis pro-inflammatory chemicals that stimulate inflammation], increase in certain hormones called androgens and the presence of a bacteria called Cutibacterium acnes.”
Gold-Olufadi says that, “some hormones increase during stress especially Cortisol and androgens which are responsible for the increase in acne during stress.” This view is also supported by a study on The Impact of Psychological Stress on Acne which acknowledges there are no clear explanations on what triggers acne but some believe that the release of androgens and glucocorticosteroids happens in times of emotional stress and as a result, acne worsens.
Who’s Prone to Stress Acne?
In short, if you have acne-prone skin, you may be more likely to get stress acne.
Gold-Olufadi says that “Most patients with stress induced acne are those with acne-prone skin. They may have an exacerbation of acne by stress where the acne worsens, or they may have had a history of acne in the past,” explains Gold-Olufadi.
She says, “Occasionally, stress induced acne can occur in those without prior acne.”
How to Treat Stress Acne
The dark marks, lesions, and scars that stress acne leaves on melanin-rich skin can be frustrating and also time-consuming to get rid of.
Gold-Olufadi recommends, “The most important thing is to identify the cause of the stress and avoid it. It is important to have a to-do list where all activities are listed in order of importance to prevent getting overwhelmed with physical stress.”
But otherwise, Gold-Olufadi says, “the acne should be managed similarly as regular acne in addition to de-stressing.”
Gold-Olufadi outlines treatments that you could get over-the-counter or under prescription for stress acne in black skin. Gold-Olufadi advises that, “topical agents such as benzoyl peroxide in strengths of 2.5 – 5%, salicylic acid, sulphur, azelaic acid are products used in managing both regular acne and stress induced acne.”
Gold-Olufadi further says, “Topical retinoids like adapalene cream can also be used at night.”
But you need to keep hydrating your skin when treating it. Gold-Olufadi instructs that, “To avoid drying out the skin, a lightweight moisturizer is necessary and the use of sunscreen with a sun protective factor of between 30 to 50 is essential.”
However, a dermatologist visit would be advisable if the stress acne is not improving. Gold-Olufadi warns that “if the stress acne appears to be worsening, a dermatologist appointment should be booked as there are other conditions with different management that may mimic stress induced acne such as fungal folliculitis.”
Dealing With Stress Acne Scars
Prevention is better than cure. To tackle your scars, you need to start work even before they start forming. Gold-Olufadi says that, “darker skin tones are prone to post inflammatory hyperpigmentation because of the type of melanin that dark skin has which is richly pigmented.”
So, to reduce the chances of scarring, Gold-Olufadi advises this. “It’s important to commence treatment early to reduce complications such as hyperpigmentation and scarring.”
Touching your face can be an unconscious action. But Gold-Olufadi warns that “people with regular or stress induced acne should also avoid touching their face frequently.” She also said you should avoid picking at your skin. “Both activities on your face increase the risk of hyperpigmentation and scarring,” she notes.
Once the scars form, there are treatments available for them. Gold-Olufadi advises that, "procedures such as chemical peels can help improve these complications.”
However, Gold-Olufadi stresses that a licensed aesthetician or dermatologist should handle such procedures because “the skin must be adequately prepared before such procedures to reduce the risk of post procedure pigmentary changes (hyper or hypopigmentation).” For example, the appearance of lighter patches on your skin can be a manifestation of pigmentary changes.
Tips for Managing Stress
Stress is an unavoidable part of life and the usual stress management tips can help.
Gold-Olufadi says“ Usual stress management tips such as meditation, yoga, and eating a balanced diet with fruits and vegetables, can help while managing stress induced acne.” She further adds, “ensuring adequate hydration can help.”
But she acknowledges that this strategy isn’t enough to control stress acne. “It’s important to note that acne will also need to be managed medically in addition to the stress management tips for better outcomes,” says Dr. Shairat.
Keep Reading: How to get rid of darks spots, according to derms
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Verma, Shyam. (2014). Acne in Persons with Dark Skin. 10.1007/978-3-540-69375-8_36.
Jović A, Marinović B, Kostović K, Čeović R, Basta-Juzbašić A, Bukvić Mokos Z. The Impact of Pyschological Stress on Acne. Acta Dermatovenerol Croat. 2017 Jul;25(2):1133-141. PMID: 28871928.
Jović A, Marinović B, Kostović K, Čeović R, Basta-Juzbašić A, Bukvić Mokos Z. The Impact of Pyschological Stress on Acne. Acta Dermatovenerol Croat. 2017 Jul;25(2):1133-141. PMID: 28871928.
Zari, S., & Alrahmani, D. (2017). The association between stress and acne among female medical students in Jeddah, Saudi Arabia. Clinical, Cosmetic and Investigational Dermatology, 10, 503-506. https://doi.org/10.2147/CCID.S148499
Sutaria AH, Masood S, Schlessinger J. Acne Vulgaris. [Updated 2023 Feb 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459173/
Jović A, Marinović B, Kostović K, Čeović R, Basta-Juzbašić A, Bukvić Mokos Z. The Impact of Pyschological Stress on Acne. Acta Dermatovenerol Croat. 2017 Jul;25(2):1133-141. PMID: 28871928.
Ayer J, Burrows N. Acne: more than skin deep. Postgrad Med J. 2006 Aug;82(970):500-6. doi: 10.1136/pgmj.2006.045377. PMID: 16891439; PMCID: PMC2585707
Zari, S., & Alrahmani, D. (2017). The association between stress and acne among female medical students in Jeddah, Saudi Arabia. Clinical, Cosmetic and Investigational Dermatology, 10, 503-506. https://doi.org/10.2147/CCID.S148499
