Have Teenage-Level Acne Again? Blame the Pandemic.

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Experiencing your worst wave of breakouts since junior high? It’s not you — it’s Covid-19. The combination of skyrocketing levels of stress, occlusive protective masks, and upended routines can have negative consequences for skin, dermatologists say.

What’s Causing Acne Right Now

Pandemic-related or not, stress is a major contributor to acne. It creates a domino effect: Our bodies respond to stress by producing more cortisol, aka the stress hormone, which in turn increases the levels of androgen, which ramps up oil production in skin. “Bacteria on the skin feeds on this oil,” explains Sonia Batra, MD, a dermatologist in Santa Monica, CA. Not only that, but the excess oil itself contributes to clogged pores, too.

On top of that, stress causes an uptick in skin inflammation. “Your skin cells are a local nervous system,” explains Melissa Levin, MD, a dermatologist in New York City and clinical instructor at NYU Grossman School of Medicine. When you’re under stress, they release a deluge of inflammatory proteins. That can trigger a number of skin conditions, such as acne, rosacea, and eczema.

And if stress has led to habits like late-night Twitter scrolling, interruptions in your sleep schedule, and seeking comfort in, well, comfort foods, those may too contribute to breakouts. “The carbohydrate-rich and sugary foods many crave during stressful times have a high glycemic index, which has been associated with acne,” says Batra. They increase levels of a hormone called insulin-like growth factor (IGF-1), which studies suggest may drive oil production. Poor sleep, meanwhile, is another source of stress for the body, increasing cortisol levels. Sleep is also skin’s dedicated time for repair, and skimping on it can further contribute to inflammation.

Another complication: You may be dealing with two types of acne. The stress-related acne is your everyday acne, or acne vulgaris. “Stress breakouts are often more concentrated along the lower face, jawline, and upper neck,” says Batra. The pimples may also be deeper and more tender to the touch. But these days, there’s also acne mechanica, which results from wearing face masks and has been dubbed “maskne”; it appears as small, inflamed bumps. “Typically, this type of acne is caused by heat that gets trapped from prolonged occlusion or friction,” says Levin. She’s found that it’s especially common with N95 masks, as they’re less breathable and create a tighter seal than other kinds of masks, confining recycled, humid air under the mask.

“The carbohydrate-rich and sugary foods many crave during stressful times have a high glycemic index, which has been associated with acne.”

How to Treat Covid-Related Acne

Choose Your Mask Wisely

Opt for masks made with breathable materials, such as cotton, if you can. Heavy-duty masks with filters aren’t necessary for daily use for most people, says Levin.

Adjust your Skincare Routine

Wash with a salicylic acid cleanser to gently exfoliate and clear pores. Also, double down on not touching your face. “Many of us tend to squeeze and touch acne when stressed, and this can worsen inflammation and lead to discoloration and scarring,” says Batra.

Introduce Vitamin A

Now is the perfect time to try a vitamin A derivative, such as retinol or retinoid (the stronger, faster-acting counterpart to retinol). “Using a retinoid, such as adapalene, at night helps decrease oil gland activity and clogging of the pores,” says Batra. While most retinoids are typically only available with a prescription, you can find adapalene over the counter in Differin® Acne Treatment Gel and La Roche-Posay Effaclar Adapalene Gel 0.1% Topical Retinoid Acne Treatment. As retinoids can cause dryness and irritation, start by using it on two nonconsecutive nights each week. “A moisturizer that doesn’t clog pores can be used as a second layer to offset dryness,” says Batra. If, after a few weeks, any dryness or irritation subsides, you can increase it to nightly.

Opt for masks made with breathable materials, such as cotton, if you can.

Get on Schedule

“Stress-reducing activities that decrease cortisol production, such as exercise, mindfulness, deep breathing, or yoga, will help,” says Batra. (Plus, they’ll aid sleep.) At the very least, Levin advises her patients to stick to a schedule, such as waking up at the same time, doing your skincare routine, and getting dressed every morning.

See an Expert

In setting off various inflammatory skin conditions, stress may lead to a case of mistaken identity. If skin is red and bumpy, “a lot of patients think they have acne, so then they treat their skin as if it’s an acne flare,” says Levin. But if it’s really, say, rosacea, you’ll only be making matters worse. If your breakouts don’t improve or you notice irritation, make an appointment (virtual or otherwise) with a dermatologist for a proper diagnosis.

I’m a writer and editor in New York City. You can find my work in Vogue, Cosmopolitan, Glamour, New York Magazine, and beyond.

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