pdf of this article

For more information about skin conditions and treatment, contact:


Elizabeth H. Hamilton, MD, PhD
Amy Stein, MD
Julie Dodge, PA-C
4321 Medical Park Dr., #102
Durham, NC 27704
Telephone: (919) 220-7546 (SKIN)

Stress and Women’s Skin

“I think it would be safe to say that, like most health care providers, we are feeling—and, hopefully, adapting to—the changes and challenges of the last six months,” observes Dr. Amy Stein of Regional Dermatology of Durham. “For a dermatology practice, however, the task is particularly challenging. While there are certainly other practices that are hands-on, in dermatology, so much of our work is touching and feeling, that it’s been a big adjustment.”

Dr. Stein

It’s an adjustment they’ve made successfully, says Dr. Stein. “We’ve all had to get used to seeing a smaller group of patients and conditions in person for a while, and we have found that for several interactions with patients, telemedicine is very effective. And we realize that this approach is our ‘new normal’,” she acknowledges, “because things are not going to be back to what used to be ‘normal’ for a very long time.”

The Pandemic, Stress, and Women’s Health

Another way the COVID-19 virus has affected their practice, observes Dr. Stein, is its indirect impact on patients’ health in the form of increased stress. “The fact is,” she says, “when there is more stress—in other words, more inflammation—dermatologic conditions can worsen significantly. Many chronic and acute skin conditions—such as acne, eczema, psoriasis, and rosacea—are particularly sensitive to stress and flare when stressors increase. There is no question that the pandemic and economic crises have added a significant layer of stress to all of our lives—stress that we see reflected in our patients’ skin.

“And for women,” she adds, “this is an even greater challenge. Not only are they physiologically more predisposed to suffer stress than men, but they typically deal with the stress of multiple responsibilities—for work and child care—responsibilities that have increased during the pandemic.

“Initially, people respond well to these new stresses; we get this fight or flight reaction,” explains Dr. Stein, “and things are held together. But as the crises continue, there’s a bit of a letdown, and we let our guard down. This is when we’re likely to see significant flares in these chronic skin problems.”

Female-Dominated Skin Conditions

Pregnant women face special challenges in terms of skin health, notes Dr. Stein. “The pregnant state is one in which the woman is relatively immune-compromised. And it’s a time when the body is in a more permissive state for growing things—including, of course, the fetus, but also an assortment of lumps and bumps. 

A common dermatological issue accompanying pregnancy is melasma, or hyperpigmentation of the face—often due to hormones. “Melasma,” notes Dr. Stein, “can also occur outside of pregnancy—caused by birth control pills, for example.  It is not specific to women, but is more common in women than men. And there’s a condition called intertrigo—a rash that occurs in skin folds—that occurs more often in women than in men, particularly large chested and/or overweight women and those who live in areas with hot, humid weather.”

Acne is one major condition that can worsen in adult women—especially in response to stress, notes Dr. Stein. “If I had a quarter for every time a woman has said to me, ‘I never had acne as a teenager. Why do I have it now?’ I’d have a lot of coins! But though women are often surprised—and dismayed—to find they have acne long after their teenage years, it’s really not a surprise. Generally, acne issues are a bit more common and intense with my female patients—patients who are living high-stress lives, juggling numerous responsibilities. And it’s pretty well established that stress agitates and exacerbates acne, making it far more difficult to treat and control at times.

“Inflammation can be a part of acne and contributes to flares,” she continues. “For example, cystic acne, with red swollen, tender knots represents a very inflammatory type of acne. We also know that inflammation in the form of irritation can contribute to worsening acne.”

Acne rosacea, another inflammatory condition, also occurs more commonly in women than men. It may be driven by hormones or stress, and stress certainly worsens it. Middle aged women are more prone to rosacea, presenting with facial redness, swollen red bumps, and sometimes visible blood vessels. While sometimes mistaken for it, rosacea is distinct from adult acne; both, however, can be triggered by medications, stress, and even personal skin care products.

While rosacea and acne tend to be more chronic, the condition perioral dermatitis typically is not. “This disorder,” explains Dr. Stein, “is another acne-type eruption, and also occurs more often in females. It can present as a dry skin acne type of breakout around the mouth, the nose or even around the eyes—often, however, it presents as red bumps or cysts on the lower face.

“There can be several triggers for perioral dermatitis,” explains Dr. Stein, “including hormonal ones. Irritation can contribute to inflammation, as can stress, lack of sleep, and diet. Sometimes the trigger is known. It might be an inhaled steroid medication or toothpaste or some other personal care product. In those cases, it’s easy to treat. And we’ve found that this is one of the conditions that we can treat through telemedicine, often with topical medications alone; there are instances that require a combination of topical and oral medications.” 

The “New Normal”

Reflecting on the impact of the COVID-19 virus on their practice and their patients’ skin conditions, Dr. Stein notes there are some benefits as well as challenges in the “new normal.”

“Our female patients tend to be more proactive about skin care, both aesthetically and being alert to changing moles or other red flags,” she points out. “And we have many patients who are on medications—such as Accutane and biologics—that require regular checking.

“I actually feel better about these patients,” says Dr. Stein, “because we know we’ll be able to stay on top of things with them. Furthermore, managing some of these chronic conditions can be done efficiently with telemedicine for the time being.

“But for other patients, there are concerns. For example, in the case of conditions such as rosacea, acne, psoriasis, eczema, I’m sure that we will wind up seeing people who are significantly flared, because they will delay seeking help for these conditions—despite our attempts to push telehealth or have them come in earlier. Likewise, many of our patients are at high risk for skin cancers including melanoma. So, I suspect we’re going to need to do a bit of a reset here. We need to remind patients that what seem to be ‘minor’ skin problems deserve prompt attention, and to assure them that they can be treated safely. Because, when neglected, many such conditions become major skin problems.”