The Stress–Skin Connection & Dr. Karam's Advice to Restore Balance

Here’s how stress changes skin biology (and why skin conditions tend to flare):

• Cortisol and the “stress switch.” When stress shows, cortisol climbs. That raises oil levels, slows repair, and even loosens the skin barrier – so more water escapes (that’s transepidermal water loss, or TEWL). The net effect is that your skin feels a bit drier and more reactive, with redness, itchiness, and pigmentary changes more likely to spike.
• Skin–nerve–immune system conversation. When you’re stressed, nerves in the skin send chemical signals. Nearby immune cells release histamine, blood flow shifts, and that chain reaction makes skin more likely to itch, sting, and feel sensitive.
• External stressors matter, too. Outside forces – UV (even on cloudy days), heat, cold, wind, low indoor humidity, and hot showers, plus pollution and smoke – drive oxidative stress and increase TEWL, so skin loses water more easily, looks dull, and may irritate.
• It’s a loop, not a line. Because visible skin symptoms can raise your stress (sympathetic and HPA systems), and that stress feeds inflammation and barrier breakdown, skin conditions like acne, eczema, psoriasis, and even hair and nail changes can get caught in a loop where episodes come faster and recovery takes a lot longer.

These are the habits I return to for grounding and balance in an otherwise non-stop life. Simple touchstones that support steady, tranquil routines and a well-protected skin barrier. 

Start with one or two tonight, keep them consistent, and you’ll feel the difference.

I go for a walk in the hills behind my house every day before work. Studies show that adding a 10-20-minute walk in sunshine helps to anchor the circadian rhythm and lift mood, and I find this is a good way to start my day off on the right foot.

I like to walk in the morning and, when possible, go where there are plenty of trees, water, or some nature to feel more grounded. Spending 20-30 minutes in nature is associated with a meaningful drop in cortisol.

Movement and stretching have been two of my most important tools when it comes to managing stress. Workouts, hiking, and daily physical activity keeps my mind and body more resilient against stress, and then I unwind every evening by stretching, foam rolling, or even just hanging from the pull up bar to help my body release, relax, and recover.

I have started doing a movement routine before surgery that also helps my body release tension, allowing for a huge downshift in my nervous system, while keeping my shoulders pain-free through long operating days. On the weekends I do yoga with Neda, which stretches different muscles, while also building strength and connection to breath.

In my own personal routine, I sit in a sauna for about 10 to 20 minutes, two to three times a week, then move straight into a one to three minute cold plunge.

Sauna heat activates the parasympathetic nervous system, loosens tight muscles, and activates endorphins that boost mood. You feel your body shift into a calmer state, and that relaxation carries into the hours that follow.  I always end on cold because it gives the body and mind a clean reset. Cold triggers focus and trains the body to recover quickly from stress.

What makes this practice so valuable is the mental component. Stepping into cold water is never easy, but doing it anyway reinforces the belief that you can handle discomfort. Each session becomes a small act of resilience. Over time, that confidence carries into the rest of your life. You sleep better, think more clearly, and feel more grounded because you've proven that you can get through hard things, instead of being overwhelmed by them.

One of my favorite ways to unwind at the end of the day is cooking with family. We meal prep ahead of time to make evenings easier, and keep our meals clean and healthy, yet delicious.

We build colorful plates filled with protein, fiber, and healthy fats to blunt glucose spikes. Steadier glucose means fewer cortisol surges and less inflammatory signals that can drive oiliness, redness, and slower repair. Low-glycemic patterns have been linked to decreased breakouts, and balanced meals support a calmer skin-nerve-immune loop. 

Make sure to also hydrate throughout the day to mitigate stress triggers. Adequate hydration supports skin barrier lipids, reduces TEWL, and eases that tight, dry pull. On hot or workout days, I always add electrolytes to replace losses and keep skin (and mood) more balanced.

If you're really feeling stressed, drink some water, it's amazing how your body will respond.

If you're feeling stressed, take about 5 minutes in the morning and/or evening to try 4-6 breathing (inhale for 4, exhale for 6) or box breathing (in 4, hold 4, out 4, rest 4). Sit up, breathe through your nose with your shoulders relaxed. Longer, quieter exhales activate the parasympathetic system and ease cortisol spikes.

Pair this breathing habit with your morning and nighttime skincare so it becomes a natural part of your routine. When practiced daily, these 5 minutes can improve sleep, support steadier stress levels, and create noticeable benefits in your overall wellbeing and skin health.

I read every night before bed. Even just 6 minutes of reading can lower stress by about 68%, which is why it’s such a great way to downshift before sleep. Choose something calming (fiction, biography), keep the light warm and low, and put phones away to truly unplug.

Reading redirects looping thoughts, slows heart rate and muscle tension, and nudges the nervous system toward rest. Do it right after your PM cleanse, while products are absorbing; the ritual improves sleep onset and quality, which supports repair, skin barrier function, and steadier stress and skin health the next day.

Aim for a predictable evening routine that helps you decompress and reset before bed. For me, that looks like: unplugging from my phone and work, cooking and spending time with my family, reading a few pages in my book, completing a light stretch before my skincare routine, a few rounds of slow breathing, and lights-out at a reasonable time.

Good sleep is so critical. It realigns circadian rhythm and cortisol timing, lowers “fight-or-flight” signals, and improves emotional regulation – so both mood and skin react less to stress triggers. Adults who average less than 6 hours/night are ~2.5× more likely to report mental distress than those sleeping more than 6 hours, and even a single night of sleep loss can elevate next-evening cortisol, which is why consistency matters in your eveing routine.

Apply broad-spectrum SPF 30+ every morning as the last step in your skincare routine. It protects against external stress like UVA/UVB and high-energy visible light, which amplifies inflammation, erodes barrier skin lipids, and triggers pigment rebound.

Use the 2-finger rule and reapply every 2-3 hours outdoors. Add smart sun behaviors, like seeking shade and wearing a brimmed hat or UPF clothing during peak UV (10 AM-4 PM). This decreases stress on your skin by lowering its light dose, keeping the skin-nerve-immune loop quieter and stabilizing the barrier.

The KaramMD Trifecta is a 3-step system with 20+ actives designed to hydrate, reinforce the skin barrier, and calibrate cell turnover day and night. Automatic refills remove decision fatigue and keep you consistent. With regular use, it helps prevent and repair visible signs of stress – dryness, redness, congestion, irritation – while supporting healthy aging. One skincare routine, no guesswork; it takes the stress out of skincare and builds lasting resilience.

When stress shows on skin, don’t overhaul the entire plan, make adjustments.

If you’ve tried simple habits like walking, breathing, hydration, etc., and are still experiencing signs of stress in your skin, here are the fixes for the most common culprits:

Breakouts That Flare Under Pressure

• Cleanse in the AM/PM; use a pea-size retinoid at night.
• Buffer with a thin emollient or aloe around breakout prone zones.
• Rinse after workouts and keep hair + phone off your face to limit congestion.

Redness/Flush or Easily Irritated Skin

• Cool rinse for 30-60 seconds, then go for a lukewarm cleanse; pat dry.
• SPF 30+ every morning to reduce stress and sun irritation.
• Avoid heat stress triggers, like hot rooms + saunas, spicy food, and alcohol.

Dry, Tight, “Itchy-For-No-Reason” Skin

• Use humectants, ceramide-rich emollients, or light occlusives on slightly damp skin.
• Keep indoor humidity at ~40-50%; apply lukewarm (never hot) water.
• Pause strong exfoliants; if you do exfoliate, use Polish 1×/week until calm.

Post-Procedure or Slow-Healing Spots

• Keep routine on the spot: cool-to-tepid cleanse, hydrate, light occlusive, hands off.
• Protection from the sun and SPF 30+ while healing.
• Minimize friction (think clean pillowcase + avoid rubbing or touching your face).

Pigment-Prone (Melasma/Post-Inflammatory Hyperpigmentation)

• Daily SPF 30+ and morning antioxidants are a non-negotiable.
• Keep a consistent nighttime retinoid on hand.
• Avoid direct facial heat: saunas, hot yoga, blow-dryers close-up.

Highly Sensitive or New to Actives

• Start with 2-3 nights/week retinoid, then build to nightly.
• Skip reaching for scrubs with hot water; patch test new steps first.
• Introduce 1 new product at a time to identify stress triggers and adjust.

We often talk about how stress shows up on skin, but the reverse is true, too. A simple, predictable ritual lowers perceived stress, builds a sense of control, and can even lift mood.

Emerging work and studies on the skin–brain axis point the same way: routine, sensory cues, and self-care support emotional well-being alongside stress and skin health.