Skin & Hair

Acne and Inflammation

September 20, 2018

Everyone single one of us experiences it—acne. And we all share the same sentiment: it’s not fun or pleasant. It makes you feel self-conscious. And physically, you may feel a bit of pressure, perhaps even some pain below your skin. A red patch starts to reveal itself on your forehead, nose, or cheek. It’s not there yet, but you know that a pimple is about to make an appearance on your face or some other part of your body. When it finally makes its grand appearance, your natural inclination may be to pop it, but this is probably not the best solution, since it may leave a scar, or lead to even more acne in the future. So, how do you get rid of this frustrating skin condition?

Acne affects nearly 50 million Americans every year, with 85% of those between the ages of 12 and 24 years old experiencing at least mild acne(1). But acne is not only associated with coming of age. Did you know many adults get acne too? Monthly fluctuations of hormones, stress, the foods we eat, drinks we consume, and the type of lifestyle we lead may be big inflammation cultivators, and they all greatly affect our skin. One thing is for sure—if you have acne, you are not alone. And fortunately, there are many treatments out there for this skin condition, with the future of acne treatments looking brighter than ever.

Recent discoveries regarding the connection between inflammation and acne and related probiotic and nutritional treatments have made our understanding of acne—and how it affects skin—clearer (no pun intended). Let’s start with talking a little bit about what exactly adult acne is, who is most at risk, and what you can do to achieve clear skin.

What is acne and who is at the highest risk?

Acne is a condition in which the hair follicles of the skin become clogged with oil and dead skin cells(2). You may be most familiar with acne showing up on the facial skin, but it can also erupt on the chest, upper back, and shoulders. There are multiple types of acne and it can be mild or severe. Here is a list of the common forms of acne(2):

  • Whiteheads: These small white bumps on the skin are basically closed plugged pores.
  • Blackheads: These small black dots on your skin, commonly seen on the nose, are open, plugged pores. Since they are exposed to oxygen, unlike their whitehead counterparts, the debris in these pores appears black.
  • Papules: These small red bumps may be tender when touched. The red, inflamed look of papules is a sign of inflammation.
  • Pimples: This type of acne is probably the one you visualize when you hear the word “acne.” However, it is just one type of acne that is basically a papule with a bit of pus at the tip. This pus is simply white blood cells mixed with tissue debris(3).
  • Nodules and cystic lesions: Nodules are large lumps that lie below the skin, are often painful, and can be found on the jawline, neck, and buttocks, along with other common acne locations(4). Cystic lesions are another severe form of acne in which nodules are filled with pus. They are very painful, and both nodules and cystic lesions can cause scarring on the skin upon clearing(5).

Although acne is seen most often in teens going through puberty, adults can get acne too(2). You are more likely to get acne if you have any hormonal changes such as those that occur during puberty or when taking certain medications. Additionally, a family history of acne, exposure to grease or oily skin products, friction on the skin from helmets, phones, or backpacks, and stress can all increase your risk of acne.

Stress, though not the main culprit of acne, can make it worse. This is because the brain, gut, and skin are all connected, and when one is inflamed, the others soon follow.

What does inflammation have to do with acne?

The question should be what doesn’t inflammation have to do with acne! Recent research shows that inflammation plays a central role in the development of both inflamed and non-inflamed acne lesions(6). It was once thought that acne was caused when the bacteria found on normal skin, Propionibacterium acnes, colonized the hair follicle(7). The theory was that after it did this, an immune response would be triggered, and the non-inflammatory blackheads and whiteheads would become inflamed lesions like papules and pustules.

However, research is now finding that inflammation may exist in the development of acne even before the whitehead and blackhead, or comedo, stage(8). In fact, there is some research suggesting those with more severe acne may have more serum levels of the immune system marker known as Interleukin-9(6), which shows that inflammation may have a key potential role in the severity of acne.

So, how can I stop this inflammation?

There is not one clear-cut answer to this question, but there are a few things you can do to try to reduce inflammation in your skin.

1. Probiotics

These friendly bacteria have gotten a lot of good press lately, and for good reason. Research shows that by restoring balance in the gut flora, some inflammatory skin conditions, like acne, could improve(9). The theory is that the bacteria in the gut produce compounds known as neurotransmitters that send out nerve signals in response to stress. These signals can in turn affect skin function.

The probiotics work to help reduce the stress response by making sure there is enough “good” bacteria in the gut to help fight off any harmful bacteria(10). By reducing stress in the body, probiotics can lessen the inflammation that can lead to conditions like acne. A 2018 study review reports results of multiple research studies that time and again show that probiotics like those from the Lactobacillus and Bifidobacterium strains can decrease acne lesion count after several months of treatment(11).

2. Changes in your diet

There is a lot of research going on to find out what foods can contribute to acne or make it worse. Contrary to popular belief, eating greasy foods doesn’t cause acne(2). This is not to say that greasy fingers rubbed on your skin after eating such foods couldn’t cause or aggravate the condition. What is known for sure is that higher carbohydrate diets are more likely to cause acne than lower carbohydrate diets.  

Multiple studies show that those who consume more high glycemic index foods like bread, rice, potatoes, and high sugar foods are more likely to have moderate to severe acne(12,13). Compared to those with no acne or mild acne, those with moderate or severe acne consumed more added sugar, total sugar, and total carbohydrates(14.15).  

Bottom Line

Although you may not be able to control or prevent all acne flare-ups, there are some lifestyle factors you can adjust to help lower your risk. Cut out the sugar and starch in your daily meals and snacks, get started on a daily probiotic, and be sure to relax. Keeping your stress levels down and your gut healthy will be a good start to getting your skin in check.



  1. American Academy of Dermatology (accessed August 17, 2018) “Skin conditions by the numbers.”
  2. Mayo Clinic (accessed July 3, 2018) “Acne.”
  3. PubMed Health (accessed August 17, 2018) “Pus.”
  4. American Academy of Dermatology (accessed August 17, 2018) “What can clear severe acne?”
  5. PubMed Health (accessed August 17, 2018) “Acne lesions.”
  6. Mochtar, M., et al. (2018) “The Difference in Interleukin-19 on Degrees of Acne Vulgaris Severity.” International Journal of Inflammation, Volume 2018, Article ID 4141579, 4 pages.
  7. Tanghetti, M.D., E.A. (September 2013) “The Role of Inflammation in the Pathology of Acne.” The Journal of Clinical and Aesthetic Dermatology, 6(9): 27-35.
  8. Askari, Ph.D., N., et al. (February 2017) “Association between Acne and Serum Pro-inflammatory Cytokines (IL-1α, IL-1ß, IL-1Ra, IL-6, IL-8, IL-12 and RANTES) in Mustard Gas-Exposed Patients: Sardasht-Iran Cohort Study.” Archives of Iranian Medicine, 20(2): 86-91.
  9. Vaughn, A.R., Notay, M., Clark, A.K, and Sivamani, R.K. (November 2017) “Skin-gut axis: The relationship between intestinal bacteria and skin health.” World Journal of Dermatology, 6(4): 52-58.
  10. Nagpal, R., et al. (2012) “Probiotics, their health benefits and applications for developing healthier foods: a review.” FEMS Microbiology Letters, 334(2012): 1-15.
  11. Salem, I., Ramser, A., Isham, N., and Ghannoum, M.A. (July 2018) “The Gut Microbiome as a Major Regulator of the Gut-Skin Axis.” Frontiers In Microbiology, Volume 9, Article 1459.
  12. Kucharska, A., Szmurlo, A., and Sińska, B. (April 2016) “Significance of diet in treated and untreated acne vulgaris.” Advances in Dermatology and Allergology, XXXIII (2): 81-86.
  13. Harvard Health Publishing: Harvard Medical School (updated March 14, 2018) “Glycemic index for 60+ foods.”
  14. Burris, MS, RD, CSSD, J., Rietkerk, MD, MBA, W., and Woolf, PhD, RD, FACSM, K. (March 2014) “Relationships of Self-Reported Dietary Factors and Perceived Acne Severity in a Cohort of New York Young Adults.” Journal of the Academy of Nutrition and Dietetics, 114(3): 384-392.
Burris, PhD, RD, CSSD, CSG, J., Rietkerk, MD, MBA, W., Shikany, DrPh, PA-C, J.M., and Woolf, PhD, RD, FACSM, K. (September 2017) “Differences in Dietary Glycemic Load and Hormones in New York City Adults with No and Moderate/Severe Acne.” Journal of the Academy of Nutrition and Dietetics, 117

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