When You're Sad, Your Skin Is Sad


Correlation doesn't prove causation, but I can't help but notice that both times I’ve lived in my teenage bedroom I’ve felt especially sad. In high school, it was an angry sadness that sought attention. But when I came back to my parents house in March to ride out COVID, the sadness became deep and dull—about everything and nothing. I go to bed dreading the next day like it holds a big test I haven’t studied for. In the morning, I alternately jolt awake while it’s still dark, or tether myself to my comforter well into the workday. I’ve been very privileged in the ways I’ve experienced the past few months, but also very anxious. And actually, the CDC estimates that 40-percent of adults exhibit symptoms of anxiety or depressive disorders as of this past July. (In 2019, that number was 11-percent.) So, yes, I’m crying a lot more than usual; maybe you are too. I’m also breaking out more than usual—and you?

“Yes, stress causes you to break out,” says Dr. Amy Wechsler, who, as one of only a handful of doctors in the US board-certified in both dermatology and psychiatry, is uniquely qualified to answer questions about this kind of stuff—she even wrote the book on it. Dr. Wechsler cites a well-known study done on a college campus during exam week, where researchers found a strong correlation between stress and the severity of acne. “But exam period is like two weeks long, and when the exams go away the breakouts go away. Imagine if you had exam period for five months, you know? That’s like what we’re going through right now.”

According to Dr. Wechsler, the root of stress acne lies in a molecule called cortisol. Cortisol is a hormone that’s pumped out by the body to fight illness, control blood sugar levels, regulate metabolism, and influence memory formation. In general it’s anti-inflammatory, but when you’re stressed, your body responds by producing more cortisol than it would normally as part of the fight-or-flight response meant to keep you alert when you need to be. If that stress is prolonged, and you don’t have the proper coping mechanisms to deal with it, cortisol starts to act very inflammatory.

“Inflammation is the root cause of acne, and eczema, and psoriasis,” says Dr. Wechsler, who also adds that high levels of cortisol over a long period of time will break down collagen, the molecule in your skin that keeps it looking plump. “That’s why when people are really stressed out for a while, they look like they aged overnight.” For a good, obvious example of this phenomenon, take a look at a photo of President Obama in his first year as president compared to his last. Cortisol also weakens your skin’s natural barrier, so you’ll start to experience more transepidermal water loss. Several months of anxiety may leave you with a totally different skin type: even if your skin is normally oily, it will start to dry out and get more sensitive. Dr. Wechsler notes that when your barrier is compromised, your skin is more likely to react to something that normally wouldn’t cause a problem. “That’s when people say things like, ‘I’ve been using the same product forever, they haven’t changed their ingredients, but now I can’t tolerate it.’”

The tricky part about cortisol is that once levels are high, it can be difficult to bring them down on your own. At minimum, you need to make sure you’re getting an adequate amount of sleep each night, which can be difficult when you’re feeling anxious. “Cortisol is at its lowest for everybody during sleep, and healing molecules like beta-endorphins, growth hormones, and oxytocin,” a mood enhancer, “are always at their highest,” says Dr. Wechsler, who compares the molecules’ relationship to a see-saw. If you’re not getting much sleep, you’re not giving the anti-inflammatories a chance to catch up to the cortisol.

During the daytime, you can sort of hack your body chemicals by engaging in activities that directly trigger a release of those happy molecules. Completing your skincare routine floods your brain with dopamine, otherwise known as the “feel-good neurotransmitter.” So would cooking a complicated dinner, or organizing your bedroom, or finishing a book. A workout can help balance too-low endorphins, a fact I always felt was fallacy until I experienced my first runner’s high a few months ago. Not into exercise? Pop on a John Mulaney stand up special—any will do!—for a rush of endorphins you don’t have to sweat for. And to raise your oxytocin levels, turn down the lights and grab your vibrator. Sex drive can lower when you’re depressed, but each time you orgasm your body releases cortisol-lowering, calm-inducing oxytocin.

Of course, these things won’t stop you from feeling anxious, but they might help you feel a little bit better on the day-to-day, and you also may see a difference in your skin. “When people are very anxious, they feel this loss of control over what’s going on in their lives, and normal routines fall by the wayside because they feel unimportant,” Dr. Wechsler explains. “A skincare routine gives you back a little control,” she adds, conceding that, at the very least, 10 minutes of caring for yourself will feel better than reading the news, or scrolling through Instagram.

The absolute easiest, low-effort way to help balance cortisol? For a sad person at least, it’s crying. Scientists aren’t quite sure how or why, but studies show that a good crying session decreases cortisol levels. It was once widely believed that tears were a way to expel excess stress hormones, but now, most researchers think that the benefits of crying have to do with social signaling: just getting out the message that you’re in distress seems to help alleviate some of that distress. And, if you’re crying to somebody, they’re likely to give you a hug, rub your back, or stroke your hair—all triggers for oxytocin.

But while crying is good for the skin internally, it can leave your face feeling… not so great. Which is the reason I called Dr. Wechsler in the first place—I wear my recent crying obviously, and am left frantically icing my face before morning meetings and check-ins with family. Beyond how I look, my post-crying face hurts. My eyes get incredibly puffy, and I often find myself stuck between a rock and a hard place when I cry at night. It happens, without fail, after I do my skincare routine, and I wasn’t sure whether the salty tears left on my skin were further contributing to breakouts. To make my outsides match my insides after a solid catharsis, I wanted to figure out a post-crying best practice—a sad girl beauty routine, if you will.

What I’d learn is that your eyes work overtime to produce tears, which draws an abundance of blood to the surface of your eyelids. If you cry at night, that blood doesn’t have anywhere to go—it pools in your face when you’re lying flat. “If you’re crying during the day and you’re standing up and walking around, gravity will take the swelling from your eyelids, bring it down your face, and flush it out,” adds Dr. Wechsler. For those particularly concerned about morning puffiness, you can stay upright until the swelling subsides, or try Dr. Weschler’s favorite method. “Put a teaspoon in a glass of ice water, let it get really cold, and then take the back of the teaspoon and put it on your eyelid with a little bit of pressure. Both the cold and the pressure really help those blood vessels calm back down,” says Dr. Wechsler, who learned the tip from one of her model patients. Doing that right away will probably help prevent morning puffiness, but if you aren’t feeling up to it, just go to sleep and try to keep your head elevated with an extra pillow. You can always try the spoon trick (and some vertical action) in the morning.

As for the tears themselves, Dr. Wechsler recommends rinsing them off to abate dryness. If you’ve cried within a half hour of doing your skincare routine, you can rinse with a gentle cleanser (or water, if you think another wash will be too drying) and re-apply your skincare products. Otherwise, just rinse and moisturize again.

Remember how I mentioned cortisol is difficult to lower on your own? If you’re experiencing symptoms of anxiety and depression, you might also consider seeking out the help of a trained therapist. While it’s easy to ruminate on how we look on the outside, it’s important to emphasize that this skin issue is indicative of a larger, internal problem. Aside from the auxiliary benefit of helping balance your skin, talking to someone can help alleviate the feelings of loneliness, grief, and uncertainty you might be feeling right now. Therapy for Black Girls, the National Queer & Trans Therapists of Color Network, and Open Path Collective all offer remote therapy options at accessible price points. You might also check out Psychology Today’s list of therapists, which is quite comprehensive—you can filter results by things like specialty, sexuality, and race. If you’re a Black woman, you can also apply for a grant from The Loveland Foundation to subsidize your sessions.

Knowing that my skin is feeling as vulnerable as I am right now, I’ve been taking it easy with my skincare. And the benefit is twofold: nixing breakout treatments lets my skin actually heal, and using fewer products means I’m more likely to actually do my routine (even when I don’t feel like it). I’ve noticed new pimples subsiding after fortifying my compromised skin barrier with products rich in ceramides, natural moisturizing factors, and lipids. I’ve also been chasing opportunities to feel good as often as I can, masked and tiptoeing around the border of my own shrunken comfort zone. Still the breakouts, and the tears, come in waves. But then again, they always have.

—Ali Oshinsky

Photo via ITG