Ask the experts: What is stress doing to my skin?



Dr Gaby Prinsloo is the medical director at the Advanced Nutrition Programme’s parent company the iiaa, and specialises in wellbeing and holistic medicine. Here she talks us through the science behind those all-too-familiar stressed skin flare-ups and looks under the skin to reveal how exactly stress takes its toll on our bodies. 


“We all know what stress feels like, especially given the events of 2020. Not only does stress leave us feeling irritable, anxious and distracted, it also affects us physically. Our muscles become more tense, breathing and heart rate speed up, we start sweating more and we often feel tired. Blood is directed to vital organs like the brain, heart and lungs, and digestion and healing slow down.



A healthy body can adapt to, and recover from acute (sudden and short) stress very well. In fact, in certain situations this can be very beneficial. However, most people nowadays experience ongoing stress. This chronic stress can overwhelm the body’s ability to adapt, leading to a host of illnesses. Prolonged stress also affects our skin, triggering or worsening inflammatory conditions such as eczema, psoriasis, rosacea and acne, delaying wound healing and speeding up the aging process. 


Stress affects skin both directly and indirectly. When we’re stressed the brain stimulates the release of adrenaline and cortisol, the two main stress hormones, into the body. These act directly on the skin to alter skin cell growth, increase sebum production, increase inflammation and impair immunity.  


Stress also affects skin indirectly via the gut. When we are chronically stressed, gut motility (the contractions of muscles that aids digestive transit) slows down and the gut microbiome falls out of balance: this is called dysbiosis. This can lead to increased inflammation in the body which has a significant effect on the skin.  


Some of the most common skin conditions are linked to stress – you may have experienced this yourself, but there are some more surprising connections between stress and skin. 




Many people experience acne at some point in their lives, and we all know that stress makes breakouts worse! When we are stressed, cortisol stimulates sebaceous glands to produce more oil which is stickier than normal. Bacteria become trapped in the hair follicles, and because the skin’s immune system is impaired, the follicles become infected. These changes together with an alteration in the skin’s microbiome, also caused by stress hormones, increase acne breakouts and problem skin conditions.  



Both eczema and psoriasis are common chronic or recurrent inflammatory skin diseases, which flare up when we are stressed. Stress hormones stimulate the release of pro-inflammatory cytokines (messengers) which increase inflammation in the skin. They also change the growth cycle of keratinocytes (one of the main skin cells), which disrupts the skin’s protective barrier and leads to dry, flaky skin. 

An impaired skin barrier increases the sensitivity of skin to allergens, making itchy flare ups more common. It also allows bacteria to penetrate the skin which, combined with an impaired immune response, increases the risk of skin infections. Skin becomes red, irritated and much more sensitive to our environment.  



Finally, stress hormones change cell growth, damage proteins and DNA, and impair the skin’s immune system and repair mechanisms, all of which accelerate ageing of the skin (and body).  

Damage to collagen and elastin, the proteins responsible for maintaining the strength, elasticity and resilience of skin, cause wrinkles and skin laxity. Wrinkles are further aggravated by dehydration caused by a disrupted skin barrier. We also see increased pigmentation from excessive growth of melanocytes, the cells responsible for pigment production.  



In addition to the direct effects of stress, when we are overwhelmed, we are less likely to engage in healthy behaviours. We often don’t exercise and sleep enough. We also tend to eat too much sugar, as cortisol triggers the brain to crave high fat, high sugar foods. While we don’t realise it, these unhealthy behaviours actually increase the physical stress on our bodies, aggravating our skin even more. 


Even though there are many stressors that we can’t change, there are many things we can do to reduce the impact of stress on our bodies and our skin. Make sure to get some form of exercise each day. Go outside, read a book, spend time with a good friend, meditate, get a good night sleep… find what works for you and what you enjoy. Focus on self-care and include things that help you to relax and recharge each day.