Noticing a sudden acne flare while battling a cold, flu, or other infection is a common experience. This is not a coincidence; the physiological response to illness directly influences the skin’s environment. While acne is typically caused by oil production, dead skin cells, and bacteria, the body’s efforts to fight infection create an internal environment that accelerates this process. Internal changes quickly manifest on the skin, demonstrating the connection between systemic health and skin appearance.
The Inflammatory Link Between Illness and Breakouts
When an infection enters the body, the immune system launches a coordinated defense that includes widespread inflammation. This systemic inflammation is necessary to destroy pathogens, but it also impacts the skin’s balance. The physical stress of fighting an illness activates the hypothalamic-pituitary-adrenal (HPA) axis, the body’s primary stress response system.
A primary outcome of HPA axis activation is the release of glucocorticoid hormones, most notably cortisol (the stress hormone). Elevated cortisol levels are detected by receptors in the skin, including those on the sebaceous glands. This hormonal signal prompts the oil glands to increase the production of sebum, the skin’s natural oil.
This excess sebum mixes with dead skin cells inside the hair follicles, creating a favorable environment for the acne-causing bacteria, Cutibacterium acnes, to proliferate. Furthermore, the inflammation from the illness introduces pro-inflammatory molecules, called cytokines, into the bloodstream. These cytokines amplify the skin’s inflammatory response, transforming minor blockages into visible, red, and painful inflammatory acne lesions like pustules and papules.
This combination of increased oil production and heightened systemic inflammation accelerates acne development. The body prioritizes fighting the infection, leaving the skin susceptible to the hormonal and inflammatory side effects of the immune response. Because sebaceous glands are sensitive to these hormonal shifts, breakouts can occur quickly after the illness begins.
How Sickness Changes the Skin Environment
Beyond internal hormonal changes, the physical and behavioral symptoms of illness create external conditions that encourage breakouts. Dehydration is common when sick, especially with a fever or reduced fluid intake, and this affects the skin barrier. A dehydrated barrier is less resilient, making it more prone to irritation.
When the skin lacks water, the outermost layer (stratum corneum) cannot function effectively to prevent water loss and block external irritants. This compromised barrier function accelerates transepidermal water loss (TEWL), causing the skin to become dry and flaky. Paradoxically, this can promote compensatory oil overproduction in some areas, creating a mixture of dryness and oiliness that encourages acne.
Behavioral changes also contribute, as malaise and lack of energy often disrupt regular skincare routines. Skipping a nightly cleanse allows dead skin cells, oil, and debris to accumulate, clogging pores. Frequent nose-blowing, coughing, or resting the face on hands or unwashed pillows introduces external bacteria and causes friction. This friction can lead to acne mechanica, often seen around the mouth and nose.
Certain common cold and flu medications, such as corticosteroids or high-dose B vitamins found in immunity supplements, can also be a factor. Steroids, in particular, are known to trigger acne flares.
Gentle Treatment Strategies When You Are Sick
Managing acne while ill requires a gentle approach to avoid further stressing the skin. The immediate priority is maintaining a basic cleansing routine, even with low energy. Use a mild, non-foaming cleanser to remove surface impurities without stripping the skin barrier. Overly harsh or drying cleansers should be avoided.
It is recommended to temporarily pause the use of high-concentration active ingredients such as retinoids, strong alpha-hydroxy acids (AHAs), or high-percentage benzoyl peroxide. These ingredients increase irritation when the skin barrier is compromised by illness and dehydration. Instead, focus on ingredients that calm inflammation and support hydration.
Topical hydration is beneficial. Use products containing humectants like hyaluronic acid or glycerin to draw water into the skin, and ceramides to help repair the barrier. Drinking plenty of fluids internally also supports the skin’s ability to retain moisture and aids recovery. A thin layer of an occlusive product, like petrolatum, can be applied to highly irritated areas, such as a chapped nose, to seal in moisture and reduce friction.
For specific breakouts, use a targeted spot treatment with a lower concentration of benzoyl peroxide or salicylic acid, applying it only to the lesion itself. Since these breakouts are tied to the illness, they typically resolve shortly after the systemic infection clears and hormonal levels return to normal. If the acne is severe, painful, or persists long after the illness has passed, consulting a dermatologist is advisable.