Authors: Richard Fried MD Ph.D

If you’ve always suspected that stress has the power to make your skin act up, prepare to feel at least a little validated. Maybe you’ve realized your eczema flares most when your job responsibilities are spiraling out of control. Perhaps it feels like a new pimple pops up every day when your personal life is in shambles.

It’s not in your head—feeling stressed out really can affect your skin—and vice versa. Here, experts discuss the science behind how stress impacts your skin, plus what you can do about it.

The unfortunate truth is that stress can upset your skin in multiple ways. One way is when stress causes inflammation, which in turn causes your skin to freak out.

“So many [skin conditions] are related to an inappropriate release of inflammatory chemicals,” Richard Fried, M.D. Ph.D., a dermatologist, clinical psychologist, and clinical director of Yardley Dermatology, tells SELF.

Ah, inflammation, that buzziest of buzzwords. At its core, inflammation is your body’s response to a perceived threat to your health. This can be a good or bad thing. Inflammation plays a crucial role in keeping you healthy, because your body needs to to defend itself from true dangers, like flu viruses. But sometimes your body can overreact to substances that are actually harmless—hello, allergies—or something that at least doesn’t require such a disproportionate response. Sometimes, that thing is stress.

“The stress response—whether we’re being chased by a saber-toothed tiger, whether we have a deadline, whether we’re having trouble with family or love—is all the same,” Dr. Fried says. “Your immune system gets ready to do battle.” It does this by releasing chemicals like interleukins, which, in order to help protect your health, cause inflammation.

If your genetics, environment, or both make you susceptible to certain skin-related ailments, this inflammation can also make them flare up. “Stress is a general trigger that can make the skin misbehave in whatever way it’s prone to misbehaving,” Dr. Fried says.

Because of that inflammation, stress can lead to flare-ups if you already have certain skin conditions, but it can also just make your skin hypersensitive.

Let’s say you’re predisposed to eczema. Feeling overwhelmed with stress is one trigger that can make its characteristic patches of dry, itchy, inflamed skin bloom across your body, according to the Mayo Clinic. Same goes with psoriasis, a condition that causes sore, irritated, scaly blotches of skin, and rosacea, which can lead to reddened facial skin and bumps that might feel hot and tender to the touch. Of course, acne is in the mix, too.

Along with these, a few other conditions are closely linked with stress, like seborrheic dermatitis(greasy patches that show up in places like your scalp; it can also cause dandruff) and telogen effluvium (when hair sheds excessively because of severe, unusual stress). “Stress and pro-inflammatory chemicals cause the hair to transition from the growth phrase to the falling out phase all at once,” Arielle Nagler, M.D., a dermatologist at NYU Langone Health, tells SELF.

Other health conditions, like skin-picking disorder (also called excoriation disorder) or trichotillomania (also known as hair-pulling disorder), have a more obvious link to stress. Shannon Bennett, Ph.D., a psychologist at Weill Cornell Medicine and NewYork-Presbyterian, describes these as impulse-control conditions that usually get worse under stress. Since the impulsive pulling or picking can be a way of trying to cope with negative emotions, feeling stressed might make a person engage in these actions more often. These kinds of disorders can have various physical and mental ripple effects, Bennett explains, from skin infections to shame and guilt.

This doesn’t mean stress will cause these conditions if you don’t have them, just that it might make them harder to manage if you do.

Even if you don’t have an actual skin condition, dealing with way more stress than usual for a significant amount of time might make your immune system hyperirritable, so something that doesn’t normally bother your skin can make it freak out, Dr. Fried explains. It’s kind of like when you’ve had a week from hell, then someone cuts you off in traffic as you’re running late to work. You might be much more likely to let forth a stream of expletives than if the same thing happened during a week when life’s been copacetic.

“We use that conceptualization for the immune system. When your immune system’s in a good mood, whatever. When it’s not, [stress] can make your skin misbehave,” Dr. Fried says. “It could be putting your usual moisturizer on, your usual fragrance, eating the same diet, or using a hair dye that has historically not made your scalp angry.”

But there’s also a pretty huge mediating factor between stress and your angry skin, and that’s how you act when you’re stressed.

If touching your face is your go-to nervous habit and you always break out when you’re stressed, that may be less a function of your immune system, and more a result of you introducing whatever’s on your hands to your face.

Acne has a lot to do with people touching their faces,” Dr. Nagler explains. “I always talk about that with my patients.”

Stress can also make you more likely to skimp on your usual healthy habits, which can come with side effects. “Usually, when we’re experiencing a great deal of stress, we spend less time taking care of ourselves,” Bennett says. “If you’re not sleeping well, if you’re not taking the time to wash your face, if you’re not eating well or drinking enough water, that can impact your skin negatively.”

This is in part because your immune system functions best when you’re taking care of yourself, but also because neglecting these things might stress you out more. It can become a brutal feedback loop.

OK so stress is bad and screwing with our skin. So if we just de-stress we’ll have great skin, right? Not exactly.

Don’t get us wrong—having a few de-stressing techniques on hand is always a good idea, whether that’s deep breathing, practicing meditation, or whatever else works for you, Bennett says.

But that doesn’t mean tamping down on stress is the magic fix that will automatically quash your skin concerns. “It’s not that if you only handled stress better, your skin would be just fine,” Dr. Fried says. In fact, putting that pressure on yourself to eliminate your stress for better skin can just make you more stressed. See where we’re going here?

Instead, the real message to take away from this is that there are lots of ways stress and your skin can affect each other. Managing your stress (and any stress-fueled behaviors that can screw with your skin) may be one part of the puzzle that can help your skin mind its manners, and when it does misbehave, at least do so less severely—but it’s not the be-all and end-all. So in addition to taking your breakouts and flare-ups as a sign that you need to chill and take time for self-care, talk to a professional if symptoms persist.

If your stress is irritating your skin or your skin is stressing you out, check in with a medical professional for help.

Dr. Fried recommends starting with your dermatologist, explaining your problem (whether that’s acne, eczema, or something else), and seeing if they can make any recommendations for how to fix it or how to find someone who can.

And about the stress component: It couldn’t hurt to discuss your added stress levels with a health care provider or therapist if possible. While stress may have a starring role here, it probably isn’t acting alone. Approaching the issue from all angles could get you that much closer to no longer wearing your stress on your skin.