The presence of skin disorders, especially in young people, can cause a significant physiological impact on their mental health and social skills. Around 80% of the population in every ethnic community has presented acne vulgaris turning it into the most common pathology of the skin . However, the same stress developed for having healthy skin can be one of the causes of this illness’s impairment.
The World Health Organization (WHO) defines stress as “the set of physiological reactions that prepares the body for action” . In other terms, it is a biological alert system necessary for survival. Different events that occur during an invidious life, such as changing jobs, speaking in public, showing up an interview, among others, can generate stress. Although it also depends on each individual’s physiological and mental state, how a physiological affection can be related to a physical skin disorder?
To understand this relationship, we need to understand the pathology besides acne vulgaris and all the factors involved in its impairment.
Acne vulgaris is a chronic inflammatory skin disorder produced by an abnormal function of the sebaceous follicles responsible for the sebum’s secretion. People with this pathology present these types of conditions: increased sebum production, providing an ideal environment for the growth of Propionibacterium acnes, abnormal differentiation of follicular cells, and inflammation. During puberty, an increase of adrenal and gonadal androgens is widespread; these are hormones involved in the secretion of sebum by the sebaceous glands. An abnormal rise of sebum secretion leads to the appearance of acne vulgaris . The hypothalamus-pituitary-adrenal (HPA) axis signals are active by stress, inducing the secretion of neurotransmitters, cortisol, adrenal androgens and, inflammatory cytokines altering the activity of the sebaceous gland triggering the impairment of some skin disorders, including acne vulgaris.
Fig. 1 Mechanism of sebum secretion by sebaceous glands
A cohort study was performed on 22 Stanford University students, both men and women, under stress caused by their examinations. The severity of acne during the exams was compared with the acne before being under this stress: the results show a statistically significant difference in acne severity during nonexamination and examination periods being the students under pressure the most affected . Moreover, studies performed on 111 patients with acne exposed to psychological stress reported a direct relationship between stress levels and the likelihood of acne impairment. Di Landro and colleagues reached the same conclusions in their study; women with a significant stress scale show a greater acne probability. ,
The evidence suggests that there is indeed an association between physiological stress and acne vulgaris leading to the use of alternative therapies for the enhance of acne, however, not to fully treat it. Little changes in our lifestyle such as playing sports or jogging, psychiatrists’ treatment, meditation or mindfulness course to clear one’s mind, can help to reduce stress leading to an improvement of acne.
As Dr. Cabrera states, skin is the faithful mirror of our frame of mind and emotions. 
If you liked this article, you will find interesting reading this information about diet and acne:
 G. Yosipovitch et al., “Study of Psychological Stress, Sebum Production and Acne Vulgaris in Adolescents,” Acta Derm. Venereol., vol. 87, no. 2, pp. 135–139, 2007, doi: 10.2340/00015555-0231.
 S. Torrades, “Stress and burn out. Definition and prevention,” Elsevier, vol. 26, pp. 104–107, 2007, [Online]. Available: https://www.elsevier.es/es-revista-offarm-4-articulo-estres-burn-out-definicion-prevencion-13112896#:~:text=La Organización Mundial de la,biológico necesario para la supervivencia.
 S. K. Brown and A. R. Shalita, “Acne vulgaris,” Lancet, vol. 351, no. 9119, pp. 1871–1876, Jun. 1998, doi: 10.1016/S0140-6736(98)01046-0.
 A. Jović, B. Marinović, K. Kostović, R. Čeović, A. Basta-Juzbašić, and Z. Bukvić Mokos, “The Impact of Pyschological Stress on Acne.,” Acta Dermatovenerol. Croat., vol. 25, no. 2, pp. 1133–141, Jul. 2017, [Online]. Available: http://www.ncbi.nlm.nih.gov/pubmed/28871928.
 A. Chiu, S. Y. Chon, and A. B. Kimball, “The Response of Skin Disease to Stress,” Arch. Dermatol., vol. 139, no. 7, Jul. 2003, doi: 10.1001/archderm.139.7.897.
 P. T. Marucha, J. K. Kiecolt-Glaser, and M. Favagehi, “Mucosal Wound Healing Is Impaired by Examination Stress,” Psychosom. Med., vol. 60, no. 3, pp. 362–365, 1998, doi: 10.1097/00006842-199805000-00025.
 E. Chlebus and M. Chlebus, “Factors affecting the course and severity of adult acne. Observational cohort study,” J. Dermatolog. Treat., vol. 28, no. 8, pp. 737–744, Nov. 2017, doi: 10.1080/09546634.2017.1329500.
 R. Cabrera, “Skin and stress,” Clinica alemana UDD, pp. 32–36.