Stress Acne in Brown and Black Skin: What You Need to Know

Written by: Beatrice Maina

Acne scars or dark marks on people of African heritage, Hispanics, Indians, and Asians 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 there is increasing evidence that emotional stress is one of 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.

So, what is stress acne and how do you manage it? We spoke to Dr. Shakirat Gold-Olufadi, a dermatologist with experience in treating skin of colour, and here’s what she had to say.

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, like going through a breakup.

“Several factors contribute to acne normally, which include increased sebum production on the areas rich in sebum, increase in certain hormones called androgens, and the presence of a bacteria called Cutibacterium acnes,” Gold-Olufadi says.

However, hormones like cortisol and androgens increase during stress, leading to stress acne. 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.

If you have acne-prone skin, you may be more likely to get stress acne. 

“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.

“Occasionally, stress induced acne can occur in those without prior acne,” she adds.

“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,” Gold-Olufadi recommends.

But otherwise, Gold-Olufadi says, “the acne should be managed similarly as regular acne in addition to de-stressing.”

Treatments could be over-the-counter or prescription ones, including topical agents such as benzoyl peroxide in strengths of 2.5 – 5%, salicylic acid, sulphur, azelaic acid, all of which are used in managing both regular acne and stress induced acne.

“Topical retinoids like adapalene cream can also be used at night,” Gold-Olufadi further says.

Additionally, hydrating your skin is incredibly important while using these ingredients. “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,” Gold-Olufadi instructs.

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.

To tackle your scars, you need to start work even before they start forming.

“Darker skin tones are more prone to post inflammatory hyperpigmentation because of our higher melanin levels”, Gold-Olufadi explains. So, to reduce the chances of scarring, Gold-Olufadi advises you 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.

Once the scars form, there are treatments available for them.

"Procedures such as chemical peels can help improve these complications. However, these should only be done by a dermatologist or certified aesthetician as the skin must be adequately prepared before such procedures to reduce the risk of post procedure pigmentary changes”, she adds.

Stress is an unavoidable part of life and the usual stress management tips can help. 

“Usual stress management tips such as meditation, yoga, and eating a balanced diet with fruits and vegetables, can help while managing stress induced acne. Adequate hydration also helps”, she explains.

However, Gold-Olufadi also 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”.