A cold, flu, or other illness often brings an unwelcome side effect: a sudden flare-up of acne. The connection between physical illness and worsening acne is biological, rooted in the body’s complex response to fighting infection and stress. When the body perceives a threat, it triggers internal mechanisms that directly impact the skin’s environment. This creates conditions conducive to new or more severe breakouts, resulting from the immune system’s mobilization and the release of specific hormones and inflammatory markers.
How Stress Hormones Increase Sebum Production
When an illness strikes, the body activates the hypothalamic-pituitary-adrenal (HPA) axis, the central regulator of the stress response. This activation leads to a surge in stress hormones, most notably cortisol, which helps the body cope with the infection. Elevated cortisol levels circulate through the bloodstream and directly affect the skin’s sebaceous glands.
The sebaceous glands, which produce the oily substance called sebum, are highly responsive to hormonal signals. Cortisol stimulates these glands to increase sebum output. This excess oil production is a foundational factor in acne formation because sebum mixes with dead skin cells, creating a plug that clogs the hair follicle.
This hormonal boost in oil creates a richer environment for Cutibacterium acnes, the bacteria naturally found in pores, to proliferate. The combination of increased oil and bacterial growth sets the stage for the development of visible acne lesions. The skin essentially becomes a more hospitable environment for breakouts.
The Role of Systemic Inflammation in Flare-Ups
The immune response to an invading pathogen is the second major mechanism driving acne flare-ups during sickness. As the body mounts a defense, it releases numerous chemical messengers called pro-inflammatory cytokines, such as Interleukin-1 (IL-1) and Tumor Necrosis Factor (TNF). These cytokines signal and coordinate the immune cells to the site of infection, but they circulate systemically.
This widespread systemic inflammation affects the skin, which is itself an immune organ. Inflammation is present at all stages of acne development, even before a pore fully clogs. The influx of pro-inflammatory cytokines exacerbates this existing inflammatory state within the skin’s pilosebaceous units.
This heightened inflammatory response transforms small, non-inflamed blockages, or comedones, into red and swollen lesions like papules and pustules. The body’s attempt to fight the illness by increasing inflammation inadvertently amplifies the local inflammation associated with acne. Therefore, the illness dramatically increases the severity and visibility of existing subclinical lesions.
Practical Steps for Managing Acne While Sick
Managing acne during an illness requires a gentle approach focused on minimizing skin irritation and supporting overall recovery. Prioritize rest, as sufficient sleep helps moderate HPA axis activity and reduces the circulating stress hormone levels that stimulate oil production.
Maintaining good hydration is important, as this supports the skin barrier function and overall health. Use a gentle, non-comedogenic moisturizer to prevent the skin from drying out, which can trigger the skin to produce even more oil.
Avoid using harsh, drying acne treatments or exfoliants while sick, as this compromises your skin barrier and increases irritation. Stick to a simple routine of gentle cleansing and moisturizing. Consistently avoid touching or picking at any lesions, especially because frequent tissue use during illness increases bacteria transfer and skin friction.