Is it true that regular stress causes a “cortisol face”?

There is a frequent reference on social media to “cortisol face”—certain external changes in people who are constantly exposed to high levels of cortisol due to daily stress. We decided to check whether such a relationship exists.

The hashtags #cortisollevels and #howtoreducecortisol, which appeared in early 2024, have already been used 140 million times, and Google reported a 400% increase in interest in the topic. in just the past year. Articles about the effect of cortisol on appearance have been published Life.ru, radio "Komsomolskaya Pravda" and magazine The Girl. Some publications in detail write about the dangers of high cortisol levels, and others report to readers: “‘Cortisol face’ is not a medical term at all, but an internet trend that is surrounded by too many distortions and quackery like the bone broth treatment.” Nevertheless, both of them publish tips on how to get rid of the negative effects.

Under the "cortisol face" in social networks imply specific appearance, which is especially expressed in the morning before taking care of yourself and applying makeup. These are primarily swelling, especially in the lower third of the face (jowl area) and cheekbones, redness, rashes, dark circles under the eyes. Also with elevated cortisol levels tie up decreased libido, bloating, formation of fat deposits. To solve the problem, the authors of the publications suggest, first, avoiding stress by any means, as well as using special pillows for sleeping, facial massagers, giving up caffeine, walking 10,000 steps a day and taking a variety of dietary supplements.

The term "cortisol face" became especially popular following the appearance of American comedian Amy Schumer in a number of television programs in late 2023 and early 2024. Then social media users noticed the star’s swollen and red face and diagnosed her with “cortisol face.” First Sumer reacted to these comments with irony and wrote on February 5 on her Instagram*: “Thank you for such close attention to my face. I have enjoyed your thoughts and feedback on my appearance, like all other women, for over 20 years.” She also reminded subscribers that she suffers from endometriosis (she previously had her uterus removed because of it) and is now facing hormonal problems, but overall her health is fine. However, on February 24, Sumer toldthat criticism on social networks prompted her to see a doctor and she was diagnosed with Cushing's syndrome, which also causes swelling of the face and redness of the skin.

Full name pathology - Itsenko-Cushing syndrome, or hypercortisolism syndrome. It characterizes the state of the body with elevated levels of cortisol. Too much hormone Maybe be caused by taking glucocorticoid drugs (for example, in the treatment of bronchial asthma and rheumatoid arthritis), or it is formed by the body itself due to pathologies of the adrenal glands, pituitary gland or hypothalamus. It turns out that the main reason for its occurrence is not daily worries about work, relationships with a partner, family and other problems. In addition to Itsenko-Cushing syndrome, there is also a condition similar in manifestations and name - Cushing's disease. This is the name for a pathology in which a benign tumor located in the pituitary gland releases too much adrenocorticotropic hormone (ACTH), which, in turn, increases the secretion of cortisol from the adrenal glands.

However, both Itsenko-Cushing syndrome and Cushing's disease occur rarely. The first is diagnosed in 40–70 people out of 1 million every year, the second pathology accounts for more than 70% of cases of the syndrome in adults and about 60–70% of cases in children and adolescents. Both pathologies are reversible, usually the treatment period ranges from two to 18 months. If the syndrome was caused by medications, doctors will suggest adjusting the therapy for the underlying disease, and if it was caused by a tumor, they will consider either surgical removal, chemotherapy, or radiation. In addition, there is a drug called ketoconazole, which slows down the production of cortisol and allows, if not to solve the problem, then to reduce the severity of the pathology. 

At the same time, changes in the contour of the face and its color are not the only and not the most dangerous symptom. Patients with both Cushing's syndrome and Cushing's disease suffer from hypertension, the formation of a special fat deposit in the back of the neck (popularly called a widow's hump), poorly healing wounds, excessive hair growth on the face, neck, chest, abdomen and thighs, or, conversely, from baldness, decreased libido or erectile dysfunction. They may experience purple stretch marks in the abdominal area, blurred vision, dizziness, muscle weakness and fatigue. The most dangerous disease accompanying this pathology is type II diabetes. Although treatment is varied and very effective, without it both Itsenko-Cushing syndrome and Cushing's disease can lead to death.

At the same time, this pathology is so rare that it is quite presumptuous to suspect it among numerous social network users solely on the basis of their appearance. Even if we assume that absolutely every patient with Itsenko-Cushing syndrome is an active user of TikTok (where the trend for the diagnosis of “cortisol face” is most popular), then out of the entire 2.5 billion audience In the social network there will be only 100,000 - 175,000 such people, that is, a few thousandths of a percent.

A constantly high level of stress is really, rather, harmful: It is associated with heart disease, hypertension, obesity and metabolic syndrome, type II diabetes and arthritis, addiction to alcohol, nicotine, prescription drugs, behavioral addictions (such as internet, food or gambling), mood disorders and anxiety disorders. With persistently high levels of stress, a person may suffer from insomnia or drowsiness, chronic fatigue, problems with thinking, and experience emotional swings. In general, alcohol abuse, together with sleep disturbances and food addiction, can lead to swelling of the face, redness of the skin, and rashes. But in this case, stress becomes the cause of certain disorders, and they, in turn, lead to a change in appearance.

Experts are skeptical about the idea of ​​everyday stress as a cause of “cortisol face.” Functional medicine doctor and co-founder of the American clinic Murthy Health Vijay Murthy explains: “Although chronic high cortisol levels can lead to facial swelling, this is usually seen with more serious endocrine disorders rather than the everyday stress that most people experience. In most cases, daily stress does not raise cortisol levels to the levels needed to produce such dramatic physical changes.” Stafford Lightman, Professor of Medicine, University of Bristol, adds: “Cortisol is primarily released in anticipation of the body's daily needs. Every morning, cortisol wakes up the brain. Its levels start to rise around 3 am to wake us up around 7:30 am. Cortisol levels gradually decrease throughout the rest of the day.” Joel Kopelman, MD, facial plastic surgeon summarizes: "As a facial plastic surgeon, I see that 'cortisol face' is not as widespread as TikTok would lead you to believe."

However, other experts point out that regular stress and elevated cortisol levels are accompanied by changes in the state of the body and in human behavior. In the scientific literature such a relationship called pseudo-Cushing's syndrome. With this medical condition, patients exhibit the signs, symptoms, and abnormal hormone levels of true Cushing's syndrome, but without abnormalities in the hypothalamus, pituitary gland, or adrenal glands. These changes may be caused by stress following surgery or serious illness, chronic alcoholism or alcohol withdrawal syndrome, major depressive disorder, or poorly controlled diabetes mellitus. Pseudo-Cushing's syndrome, caused by alcohol abuse, is especially well described, and how note experts, it can develop after a relatively short-term addiction to strong drinks, and not after many years of addiction. Stress caused by a quarrel with a partner or, for example, problems at work, is often “filled with” alcohol - and this, in turn, leads to changes in appearance. Or, due to problems at work, a person becomes nervous, sleeps poorly, eats more than usual or adds an unusual amount of sweets to his diet (“stress eating”), and then faces changes in appearance that will occur against the background of increased cortisol production. However, you shouldn’t automatically blame cortisol for everything - lack of sleep for any other reason or unhealthy diet in themselves negatively affects your appearance.

Some recommendations on how to get rid of the “cortisol face” are logical: for example, adjust your sleep schedule, don’t forget about physical activity, and eat a balanced diet. Other advice either has no proven effectiveness or is even dangerous. For example, “Verified” has already parsed that 10,000 steps per day is by no means a universal recommendation. And dietary supplements that do not undergo proper control during manufacture can do not contain the declared substance or even cause hospitalization.

Thus, although constant stress is rather harmful to the body and can lead to health problems, most often it is not able to ruin the appearance of the face in the way that beauty bloggers describe it. In general, high cortisol levels caused by Cushing's syndrome or Cushing's disease can cause swelling, redness, and rashes, but this pathology is rare. Even if we assume that absolutely everyone suffering from the pathology is an active user of TikTok, their number is small, only a few thousandths of a percent of the entire audience of the social network.

Cover image: Image by Engin Akyurt from Pixabay

Mostly not true

What do our verdicts mean?