A new study finds that acne folklore is right: Stress does make the zits pop out.

It’s a small study, with just 22 acne sufferers, but it shows the condition gets worse for college students facing the stress of examinations, says a report in the July issue of the Archives of Dermatology.

We were interested in exploring whether the association people commonly thought existed was true or not, says study author Dr Alexa Kimball, associate professor of dermatology at Stanford University School of Medicine. This is the first look at that relationship. And although the numbers are small, the findings are clinically and statistically significant.

Strong acne-stress link found
Kimball enlisted 22 Stanford students, 15 women and 7 men, with varying degrees of acne. Dermatologists rated each person for severity about a month before an examination period and again just before and after they took their exams. The students also filled out questionnaires about their stress levels.

Their acne was assessed on the standard Leeds scale, and the results are reported in strict scientific form, taking possible confusing factors into consideration.

By using logical regression and adjusting for change in sleep hours, change in perceived sleep quality, change in meals per day, and change in perceived diet quality, an increase in stress strongly correlated with a progressive increase in acne severity, the report says.

Blame it on hormonal changes caused by stress
Each assessment of acne severity by a dermatologist was backed up by that of a separate investigator, who looked at pictures of the students. The assessments agreed in 16 of the 19 cases that were photographed.

There are several possible explanations for the effect of stress on the skin, Kimball says. Most likely it is due to hormonal changes caused by stress, especially the glucocorticoids, she says.

Speaking for myself, I’ve noticed this for years, but there has not been good literature to support it, says Dr Marsha Gordon, associate clinical professor of dermatology at Mount Sinai School of Medicine in New York City. This does provide some support.

Solution to exam zits
The two dermatologists agree on the best way to handle the problem: don’t pile on medication, but try ways of making stress more manageable.

There have been studies showing that relaxation and imaging techniques are helpful for people with acne, Kimball says.

Learning stress-reduction techniques is really a good idea, Gordon says.

And the benefits are more than skin-deep, she says: Later in life those techniques can help manage hypertension, migraines and so on.