One thing that has always been suspected of casing acne is stress. Where there is severe or prolonged emotional stress or tension acne is likely to be more severe. This can have a circular effect, particularly in teenagers. The teenagers is under stress, usually about a social situation. Their acne gets worse, which makes the social situation more difficult, which makes the stress worse. It is very hard for some teenagers to break out of this downward spiral.
So they stress. Because they think either they have to live with an impractical diet or keep having acne.
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