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This Is Your Skin on Stress


New York Times posted "
This Is Your Skin on Stress" and features Visha Skincare founder, Dr. Purvisha Patel's expert commentary on the correlation between stress and skincare, and highlights Dr. Patel’s insights on the benefits of crying as a stress-reliever.

Psychological strain can show up as “stress skin.” Treating it is easier (and more affordable) than you think.

It starts in utero.

A mass of cells divides and develops, splits and stretches, and from a single layer of embryonic tissue, two seemingly separate but inherently interconnected systems are born: the brain and the skin.

They are bound for life. When one senses embarrassment, the other blushes. When one senses pain, the other processes it. And when one bears the burden of a pandemic, political unrest, systemic racism and the ever worsening effects of climate change … well, the other gets a pimple.

Or perhaps, depending on your genetic predispositions, it’s not a pimple but an eczema outbreak. A psoriasis flare-up. A bout of rosacea. A dehydrated, dull, oily or even — gasp — older-looking appearance. General blah-ness, if you will.

This is your skin on stress.

“There are two different types of stress: acute stress and chronic stress,” said Dr. Whitney Bowe, a dermatologist and the author of “The Beauty of Dirty Skin.” A quick surge of stress can be a good thing. It may heighten your senses, enhance mental clarity and help create collagen to facilitate wound repair. It’s there and it’s gone.


It’s the chronic, continuing stress, the kind that every sentient being is likely experiencing right now, that takes a toll on the skin.


It takes a toll on the entire being, of course, and a compromised complexion is the least of its consequences. But “the skin is the organ that we see,” as Dr. Loretta Ciraldo, a dermatologist and founder of the Dr Loretta skin-care line, put it. And in a society where unsustainable stress is not only the norm, but sometimes a celebrated sign of success, what better way for the subconscious to cry out than “stress skin”? (It is, after all, easier to ignore your feelings than your face.)

Here’s How Stress Affects Your Skin

Much of the skin-psyche connection comes down to the overproduction of cortisol, the primary stress hormone, and its effect on the skin barrier.

“The barrier traps moisture in and keeps allergens, irritants and pollutants out,” Dr. Bowe said. It effectively does the job of most skin-care products on the market, sans products, and needs three things in order to thrive: oil, water and the microbiome. Cortisol depletes them all.

During times of stress, cortisol slows the production of beneficial oils. “We get dry, rough and much more irritated because those healthy oils act as a protective layer for us,” Dr. Ciraldo said. Without adequate lipids to seal in hydration, the skin starts to “leak” water in a process known as transepidermal water loss (TEWL).

Under ideal conditions, the microbiome renders topical skin care all but superfluous. There are microbes that feed off sebum, which helps sustain healthy oil levels. There are microbes that feed off dead skin cells — the original exfoliators! There are microbes that produce peptides and ceramides, two buzzed-about beauty ingredients that keep skin firm and moisturized. There are microbes that offer protection from pollution, sunlight and invading pathogens.

“If you’re not producing enough of those healthy fats and not maintaining a healthy barrier, though, you’re altering the terrain on which these microbes grow and thrive,” Dr. Bowe said. “Imagine stripping the soil of all the nutrients and seeing if your vegetable garden is going to grow. It’s the same for the skin.”

In turn, the microbiome may experience an overgrowth of so-called bad bacteria (like C. acnes, the strain associated with acne) and a dearth of good bacteria. The microbiome becomes more prone to infection, irritation, inflammation and hyperpigmentation. It becomes more sensitive to outside aggressors, like the free radicals generated by pollution.

Stress prompts the body to produce internal free radicals, as well. “You can think of free radicals like little missiles,” Dr. Bowe said, in that they target cells for destruction and cause oxidative stress. When free radicals target DNA, it leads to skin cancer. When free radicals target elastin and collagen, it leads to fine lines and wrinkles. When free radicals target lipids, it leads to dehydration and skin barrier damage and acne.

Chronic exposure to cortisol also inhibits the production of hyaluronic acid and collagen. “These are what keep the skin plump and youthful,” Dr. Bowe said. “When you can’t make enough, the skin gets thinner.”

Sadly, hyaluronic acid serums and collagen creams can’t counteract cortisol. Topical ingredients don’t serve the same biological purpose as those produced in the body and rarely penetrate to the lower layer of the dermis, where collagen and hyaluronic acid naturally occur.

In fact, skin-care products aren’t the answer to stress skin at all.

“Most products are meant for consumers who have a healthy skin barrier,” said Ron Robinson, a cosmetic chemist and founder of BeautyStat Cosmetics. Exposing an already broken barrier to active ingredients — or too many ingredients — only exacerbates existing issues.

For this reason, Dr. Ciraldo recommends removing barrier-degrading ingredients like glycolic acid, salicylic acid, benzoyl peroxide and retinol from your stress skin routine. “They are very drying, and they really do deplete the normal, healthy barrier function,” she said.

Dr. Bowe advises that you avoid any leave-on products with essential oils in them, because they can cause irritation. “A lot of people think they’re calming and soothing, but for the skin, that’s not the case,” she said.

Exceptions can be made for barrier-boosting ingredients, like glycolipids (found in Dr Loretta Intense Replenishing Serum), fatty acids (found in Symbiome Respond Postbiomic Oil) and ceramides (found in BeautyStat Pro-Bio Moisture Boost Cream).

To Heal Stress Skin, Address the Stress. Here’s How.

Managing stress may seem nearly impossible, considering that so many modern stressors are systemic. Yet according to Dr. Heather Woolery-Lloyd, a dermatologist, “90 percent of our stress is not the stressor itself, but how we deal with that stressor.”

In other words: While meditation can’t mitigate global warming, it can, at the very least, clear your complexion.

Meditating, Dr. Woolery-Lloyd said, initiates “the relaxation response,” which activates the body’s parasympathetic nervous system and decreases cortisol and inflammation. With consistent practice, the skin barrier can stop leaking and start locking in moisture, suggesting that the fabled inner glow is less symbolic than scientific.

Dr. Ciraldo tells her patients to think of meditation as “The Life-Changing Magic of Tidying Up” for the mind. “Try to find a spot when you’re going to sit quietly for 20 minutes a day and really go through your thoughts like you would your closet,” she said. “If something comes into your mind that doesn’t give you joy, put energy into discarding that thought.”

Not into meditation? No matter. Breathing, which may beat drinking water as the most eye-rollingly simple yet undeniably effective skin-care tip, is enough. Research from Dr. Herbert Benson at Harvard Medical School shows that taking slow, deep breaths triggers the relaxation response and, Dr. Bowe said, “can stop psychological stress from being translated to physical inflammation in the skin.” Breath work classes, like those offered on the holistic healing hub ALTYR, can help with technique.

“Do not put on CNN with John King up there five minutes before bed,” Dr. Ciraldo said, which is to say, beware the blue light emitted from electronics. It interrupts your circadian rhythm and leads to lower-quality sleep, which is linked to increased cortisol, free radical damage and inflammation.

“Something as simple as sleep can change the skin barrier,” Dr. Woolery-Lloyd said.

To address and prevent free radical damage, fill your plate with antioxidants, which stabilize these unstable molecules to leave skin clearer, calmer, brighter and more even toned. Vitamins A and C (abundant in fruits and vegetables), lycopene (found in tomatoes), astaxanthin (salmon) and polyphenols (green tea, dark chocolate) are all great options, according to Dr. Bowe.

Exercise increases antioxidants, as well. (Behold, the body produces yet another popular skin-care ingredient on its own.) It lowers cortisol levels, meaning fewer breakouts and a stronger skin barrier. And if you’re exercising outdoors? Even better.

“I’m a big believer in the healing power of nature,” Dr. Woolery-Lloyd said. “People say, ‘I don’t have the time,’ but it doesn’t have to be this drawn out thing. Just going outside and seeing a tree and looking at a few birds is proven to lower inflammatory markers in our body.”

If all else fails, cry.

“Crying is a stress reliever and helps decrease cortisol levels,” said Dr. Purvisha Patel, a dermatologist and the founder of Visha Skincare. “This can result in fewer breakouts.” She notes that orgasms have a similar effect on cortisol (and are, by all accounts, more enjoyable).

“This isn’t B.S.,” Dr. Ciraldo said. “These are things we can do for our skin and ourselves that don’t cost anything, but the reward is great.”

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