Do you experience a puffy face frequently? It may be concerning. Facial swelling, commonly known as a puffy face, may signal elevated cortisol levels, a hormone produced by the adrenal glands in response to stress. While cortisol is essential for various bodily functions, chronically high levels can lead to ‘Cushing's syndrome,’ a condition characterised by distinctive physical changes, including facial puffiness. So how do you know if you have a high cortisol level? We got in touch with Dr DM Mahajan, Senior Consultant, Dermatology, Indraprastha Apollo Hospitals who shares symptoms to watch out for.

Dr DM Mahajan shares high cortisol levels can contribute to facial puffiness through several mechanisms:

- Fluid Retention: Cortisol affects the body’s fluid balance, increasing water retention in facial tissues.

- Fat Redistribution: Excess cortisol can cause fat to accumulate, particularly in the face, neck, and trunk.

- Weakening of Connective Tissue: Cortisol can weaken collagen, a protein that provides skin structure, resulting in puffiness and a rounder facial appearance.

Dr Mahajan explains patients with elevated cortisol levels may show:

- Moon Face: A round, full appearance resembling a full moon.

- Facial Redness: Due to thinning skin and visible blood vessels.

- Acne or Oily Skin: Increased oil production stimulated by cortisol.

- Increased Facial Hair Growth: Particularly noticeable in women.

However, facial puffiness alone is not a definitive indicator of high cortisol levels and could be attributed to other factors such as allergies, sinus issues, or certain medications.

Dr DM Mahajan shares that if a health expert suspects high cortisol levels due to facial puffiness and related symptoms, they may recommend the following tests:

- 24-hour Urinary Free Cortisol Test: Measures cortisol levels in urine over a full day.

- Late-night Salivary Cortisol Test: Assesses cortisol levels in saliva during the evening when levels should be at their lowest.

- Dexamethasone Suppression Test: Evaluates cortisol response to a synthetic steroid.

- Blood Cortisol Test: Measures cortisol levels in the blood at specific times.

Treatment for elevated cortisol levels varies depending on the underlying cause. If Cushing's syndrome is diagnosed, options may include:

- Medication: To reduce cortisol production.

- Surgery: To remove tumours causing excess cortisol.

- Radiation Therapy: In some cases.

As cortisol levels normalise, facial puffiness generally improves, although the face may take time to fully return to its previous appearance.

Other potential causes of facial puffiness include:

- Hypothyroidism

- Allergic Reactions

- Kidney or Liver Disease

- Certain Medications: Such as steroids

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