The largest study ever conducted on acne and stress reveals that teenagers who were under high levels of stress were 23 percent more likely to have increased acne severity, according to researchers from Wake Forest University School of Medicine and colleagues.

“Acne significantly affects physical and psychosocial well-being, so it is important to understand the interplay between the factors that exacerbate acne,” said Gil Yosipovitch, M.D., lead author and a professor of dermatology. “Our study suggests a significant association between stress and severity of acne.”

he results of the study, which involved 94 adolescents from Singapore, are reported today in Acta Derm Venereol, a Swedish medical journal.

While psychological stress had been identified among many factors that can worsen acne, there has been little research to understand the mechanisms behind this relationship. The current study looked at whether levels of sebum, the oily substance that coats the skin and protects the hair, increase in times of stress and are related to acne severity. Hormone levels, sebum production and bacteria are all known to play major roles in acne.

The study involved secondary school students in Singapore with a mean age of 14.9 years. The students’ self-reported stress levels and acne severity were measured at two different times – just before mid-year exams and during summer break. Students’ long-term career prospects are influenced by the results of the examinations and they are known to induce psychological stress.

Stress levels were measured using the Perceived Stress Scale, a 14-item, self-questionnaire that is widely used in stress research. Acne severity was measured using a system that classifies acne based on type and number of lesions. Ninety-two percent of the girls and 95 percent of the boys reported having acne.

Acne is an inflammatory disease of the skin caused by changes in the hair follicle and the sebaceous glands of the skin that produce sebum. The oily substance plugs the pores, resulting in whiteheads or blackheads (acne comedonica) and pimples (acne papulopustulosa).

The researchers suspected that stress increases the quantity of sebum, which leads to increased acne severity. However, the results showed that sebum production didn’t differ significantly between the high-stress and low-stress conditions.

The researchers did find that students reporting high stress were 23 percent more likely to have increased severity of acne papulopustulosa. Levels of stress were not linked to severity of acne comedonica.

“Our research suggests that acne severity associated with stress may result from factors others than sebum quantity,” said Yosipovitch. “It’s possible that inflammation may be involved.”

Singapore was selected as the study location because sebum production is known to fluctuate with variations in temperature and humidity. In Singapore’s tropical climate, temperature and humidity are consistent throughout the year.
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The research was funded by the National Medical Research Council of Singapore.

Co-researchers were Aerlyn Dawn, M.D., from Wake Forest, Mark Tang, M.D., Chee Leok Goh, M.D., and Yiong Hauk Chan, Ph.D., all from National Skin Center and National University of Singapore, and Lim Fong Seng, M.D., from National Healthcare Group Polyclinics, Singapore.

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Wake Forest University Baptist Medical Center