‘My adult acne dictated my life for a decade – until I realised it was caused by stress'
The medical explanation for how how stress impacts skin
This link between psychological stress and skin health is now well supported by science, says Dr Ahmed. Stress alters the immune response in the skin, increases inflammation, and disrupts the skin barrier – making it more reactive to heat, fragrance, pollution, even sweat.
'When you're stressed, the hypothalamic-pituitary-adrenal (HPA) axis is activated, flooding the body with cortisol, a hormone that slows down wound healing, reduces immunity, and increases inflammation,' Dr Ahmed explains.
'Even the microbiome on your skin changes under stress,' she adds. 'Because the skin itself contains its own stress response system – meaning that even over-cleansing or exposure to pollution can cause visible flare-ups. So stress is really not just in your head, it's in your actual cells. What's more, people don't realise, or perhaps forget, that your skin is a sensory organ, so it reflects how safe, or unsafe, your body feels.'
Dr Ahmed believes several factors lie behind the rise in her patient numbers: burnout, increased screen time, poor sleep, dietary shifts, and the pressure of constant self-surveillance through social media. 'We're living in high-alert mode, and our skin is reflecting it,' she says.
Taking a deeper, holistic approach
In Kiara's case, it wasn't until she began working with a nutritionist that things started to shift. 'I'd dismissed nutrition as irrelevant,' she admits. 'But once we looked at my gut health, inflammation, and hormones – and yes, stress! – it all made so much more sense.
Kiara also radically simplified her skincare routine – ditching aggressive acids and focusing on calming, barrier-supporting products instead.
But, even more importantly, says Kiara, was shifting her mindset. 'It wasn't just about skin. I had to sort out the decade-long relationship I had with my self-esteem that was the very thing causing the stress and anxiety.'
The emotional scars that last longer than the spots
Interestingly, even when symptoms improve, patients often take far longer to recover emotionally, says Dr Ahmed. 'There's something we call 'psycho-lag,' where the skin clears before the person feels safe or confident again. They've lived with fear, shame, trauma. It doesn't vanish overnight. But it can be worked on.'
For Kiara, the final turning point came when she began speaking openly about her experience. 'I started an Instagram account, initially anonymously, no face, just words. And the messages came flooding in from other sufferers: 'Me too', and 'I thought I was the only one.' That's when I realised this isn't just about skin – it's about connection, confidence, and finally being seen. That's instant stress relief.'
Today, Kiara's confidence – and her complexion – is so vastly improved she's changed careers. After qualifying as a master NLP practitioner, the psychology graduate now works as a skin confidence coach, helping people with the mental and emotional scars of acne.
'Looking back, the most damaging part of my experience wasn't the spots themselves, but the lonely silence around them. No one talked about how spots made you feel, so I thought I was the only one dealing with it as an adult. I want to get the message out that talking helps relieve stress, and stress relief can only be a good thing for your skin.'
How to support stressed skin
Dr Alia Ahmed's evidence-based tips for protecting your skin during times of stress
Sleep matters – as does timing
Sleep deprivation elevates cortisol and delays healing. The skin regenerates overnight. Aim for seven to nine hours, starting before midnight, because your circadian rhythm matters, so eight hours starting at 2am is not the same as sleeping from 10pm. Your cortisol needs to drop for proper healing.
Stay hydrated
Aim for 1.5–2 litres of water daily. Not just for 'plump' skin, but for gut health, detoxification, and microbiome balance. I also recommend good fats (like omega-3s), probiotics, and vitamin D, especially in darker-skinned individuals, or during UK winters.
Feed your skin from the inside
There's actually no strong scientific evidence that chocolate or dairy directly cause skin conditions. But we do know high-glycaemic foods can trigger acne in some people. So if someone cuts something out and sees a difference – great. Just make sure they're replacing nutrients properly, and willing to reintroduce them if there's no improvement.
Prioritise healthy fats (like omega-3s from fish or flax), fibre-rich vegetables, and probiotics or fermented foods to reduce inflammation
Watch alcohol intake
I don't say 'never drink, 'just be realistic. If you're flaring up, don't stack back-to-back nights out and then wonder why your face is inflamed. Alcohol is a clear trigger for rosacea and psoriasis, and it dehydrates the skin. But I'm no killjoy, live your life as you want to, just understand the consequences.
Keep it simple
Avoid aggressive acids or actives when your skin is inflamed. Stick to a gentle cleanser, barrier-repairing moisturiser, and daily SPF (sun protection factor). For Kiara, I advised Tolpa Sebio CICA night cream.
Laser treatments
More people are asking about these. AviClear is an FDA-approved treatment for acne which is available in the UK, and evidence has shown it can effective when used on its own, or alongside oral and topical treatments. I don't use it in clinic currently, although am looking into it. At-home red light treatments don't have as much research behind them yet, and can be expensive, so discuss with a professional before investing.
Rethink how you relax
You might think it's too 'woo woo,' but I do recommend journaling, breathwork, walking, or even ten minutes of solitude on your commute, because these things all help regulate the nervous system. Not everyone needs to meditate if they don't fancy it; but everyone needs to decompress.
Ask the right questions
If your skin condition is affecting your mental health, raise it with your GP. You can request integrated support or referral to psychodermatology services, where available. Don't suffer alone.
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