In inflammatory-type acne, there’s an imbalance between free radicals and antioxidant defenses. As the antioxidant defense gets overwhelmed free radicals cause tissue damage, resulting in oxidative stress. The immune system responds to damage, which then causes inflammation in the area.

The overwhelmed antioxidant system cannot adequately protect the skin against environmental damage; e.g. solar radiation and air pollution. Without adequate antioxidant protection, the fatty acids in sebum are vulnerable to oxidative damage. And as we covered in the what causes acne section, this is the triggers that kicks off the acne formation process.

The main focus of treating inflammatory-type acne is to identify and eliminate the sources of oxidative stress. We can also support the antioxidant defense with strategic supplementation, though this is nowhere nearly as effective as eliminating the source is.

Reducing oxidative stress takes off the pressure from the antioxidant defense system and allows it to protect the skin, which often leads to marked improvement in acne.

Before we move on, I must stress one thing. There’s far less research on areas related to inflammatory-type acne than for many other acne types. As such, the recommendations made in this chapter are not as well evidenced as the recommendations in the other chapters. I’ve used whatever evidence there is and made educated guesses on the rest.

As far as I can tell, there are a handful of major sources of inflammation that are applicable to most people:

• Bacterial toxins, such as lipopolysaccharides (LPS). LPS are substances found in outer membranes of many harmful bacteria. In large quantities, this toxic substance can cause septic shock and even death. Chronic exposure to smaller amounts causes systemic inflammation and insulin resistance and has been linked to many of the chronic diseases common in modern societies. Gut bacteria are the most common source of LPS exposure. As a result of intestinal permeability, or leaky gut, these substances can leak into the bloodstream. Chronic dental problems are another potential source.
• Advanced glycation end products (AGE) are toxic substances formed when foods, especially protein and fat-rich foods, are cooked at high temperatures. Frequently consuming such foods has been shown to cause inflammation and insulin resistance. Likewise, consuming foods low in AGE has been demonstrated to reduce the same problems.
• Histamine is a natural substance that’s involved in regulating the immune system. People with inflammatory-skin problems often have histamine intolerance. An enzyme called diamine oxidase (DAO) normally detoxifies foodborne histamine in the gut and prevents it from leaking into the body. Deficiencies in the DAO enzyme allows excess histamine to enter the body and cause allergy-like and inflammatory problems. Studies have shown that people with skin problems often have higher than normal histamine levels and that reducing histamine can improve the skin.
• Inflammatory foods. Certain foods cause inflammation in the body. Trans-fats are by far the worst offenders in this category. Sugar, and especially fructose, is another potential offender.
• Stress and poor emotional control. Numerous studies have shown that stress causes an increase in inflammatory markers. Furthermore, the degree that these markers increase depends on how well the person handles the stressful situation. Under stress, those who can better handle it tend to get less inflammation and experience fewer adverse effects.

Less common sources of inflammation include:

• Food allergies and sensitivities.
• Certain supplements. For example, it has been shown that excess doses of vitamin B12 transform the skin bacteria into more aggressive variations that can drastically increase inflammation in the skin.