What triggers inflammatory acne?

Every instance of inflammatory acne - from mild to severe - starts off as a small pore blockage called a microcomedo. Almost invisible to the naked eye, these blockages slowly evolve into the inflamed pimple that you see on your skin’s surface causing it to swell and eventually rupture. When this happens, white blood cells rush to the site to initiate the healing process which results in the redness and irritation that you see on the surface of your skin. 

While that is technically how inflammatory acne starts on the skin, in functional medicine, we aim to identify what triggers inflammatory acne underneath the surface. In reality, inflammatory acne is just the manifestation - a warning signal from your body - that something is not quite right.

The Gut-Skin Axis

In functional medicine, the gut-skin axis refers to the bidirectional relationship between the health of your gut and your skin. Ultimately, the condition of your gut influences the health of your skin and vice versa. For example, a compromised gut barrier, better known as "leaky gut syndrome," can allow toxins to enter the bloodstream, triggering systemic inflammation that have been shown to be directly linked to skin problems like eczema, psoriasis, and yes, you guessed it, acne. Conversely, chronic skin conditions can impact the gut-skin axis by causing stress, altering the gut microbiome, and influencing immune responses.

Types of inflammatory acne

There are actually four types of inflammatory acne that you can identify by their appearance.

• Papules: Small, raised bumps with a red base indicating the presence of an underlying bacteria infection
• Pustules: Characterized by white or yellow centers that signify that your body is trying to fight the infection
• Nodules: Larger, often painful bumps underneath the skin’s surface
• Cysts: Deep, pus-filled lesions that can lead to scarring

Each one of these types of inflammatory acne, while different in appearance, all form from the same cause and can be painful.

What about hormonal acne?

Affecting close to 80% of the population, I’m often asked about hormonal acne and what exactly differentiates it from regular or inflammatory acne. Hormonal acne occurs when the balance of hormones, particularly androgens (male hormones), estrogen (female hormones), and progesterone, becomes disrupted. These hormonal imbalances can lead to an overproduction of sebum, the skin's natural oil, which can clog hair follicles and contribute to the development of acne.

Hormonal acne often looks similar to inflammatory acne as it is characterized by deep, inflamed lesions such as cysts, nodules, and pustules. But unlike inflammatory acne that can occur anywhere on your skin, hormonal acne appears mainly along the jawline, chin, and lower face. It also tends to flare up during specific times in a person's hormonal cycle, such as before menstruation, during pregnancy, or during menopause, whereas inflammatory acne can be a constant ongoing issue. Women between the ages of 20-40 tend to struggle the most with this problem due to the likelihood of fluctuating hormones during pregnancy, menopause, and menstruation.

How do you get rid of inflammatory acne?

In some cases, inflammatory acne can go away on its own without any intervention, but since it is a result of underlying inflammation, targeted skincare and lifestyle changes offer a more effective, long-term solution. If you are struggling with inflammatory acne, these are the first steps I recommend taking to heal your acne and support glowing skin from within.

1. Assess your diet

Once we understand how the gut-skin axis influences the development of inflammatory acne, we can see just how important it is to eat well. While there is no one-size-fits-all diet that works for everyone, eating for clear skin comes down to eating an anti-inflammatory diet consisting mostly of clean, whole foods and little inflammatory processed foods and sugar. From gut supporting foods like bone broth to anti-inflammatory foods like turmeric and wild-caught seafood there are many nutrient-dense superfoods that will help you win the battle against inflammatory acne.

2. Target your supplements

• Omega-3s: Studies have found (1) that supplementing with omega-3 fish oil, like my supplement The Omega+,  resulted in a significant improvement in inflammatory acne.
• Probiotics: Support your gut-skin axis with a daily probiotic supplement like The Probiotic from my supplement line, that addresses imbalances in your microbiome (2) and helps to drive-down inflammation triggered by problems like leaky gut syndrome.
• Zinc: This micronutrient has been shown to help control the production of excess sebum reducing the likelihood of clogged pores. It can also lower inflammation (3) and acne-causing bacteria on your skin.

To learn more about the right supplement for your specific type of acne, check out my article here.

3. Use antimicrobial and anti-inflammatory products

To fight surface level inflammation and rid your skin of acne-causing bacteria, you’ll want to choose products that contain antimicrobial and anti-inflammatory ingredients. My favorite is tea tree oil as it is both a superstar antimicrobial that can also soothe inflammation on your skin. In fact, studies have shown (4) that tea tree oil was able to improve acne in individuals with mild to moderate cases of inflammatory acne.

Helpful preventative skin care tips

In addition to those targeted tools to treat the root cause of inflammatory acne, you can help prevent the development of new acne with these tips.

1. Choose clean beauty products

Not every beauty product is created equally. Always look for makeup and skincare products that are labeled oil-free and non-comedogenic as these won’t clog your pores and lead to future breakouts.

For an inside look at my personal skincare routine and my favorite clean beauty products, check out my article here.

2. Don’t pick your face

It can be tempting to pop your zits, especially when they are painful and you can see them start to rise to the surface. However, when you do this it can push bacteria and dead skin cells deeper into your skin and the surrounding area, increasing your likelihood of scarring and more breakouts in that area.

3. Cleanse your skin regularly

While this one seems obvious it is still important to mention. Washing your face at night is essential to cleanse your skin of makeup, dead skin cells, and sweat that accumulates throughout the day, but it is also important to cleanse your skin whenever you are finished exercising - don’t forget to also wash your back and chest where breakouts can also happen!

I also encourage people to incorporate some sort of gentle exfoliating scrub into their routine to properly remove dead skin cells that regular cleansers don’t always get all of.

Seeking help from a functional medicine doctor

Recognizing that inflammatory acne is not merely a surface issue, but a reflection of internal imbalances, you can begin to overcome inflammatory acne. If you are struggling with acne - inflammatory, non-inflammatory, or hormonal - schedule a telehealth consultation today to learn more about how we can help you using functional medicine. Through diagnostic testing and a comprehensive look at your entire health case including diet, environmental and lifestyle factors, my team and I can help you identify the root cause of your skin problems in order to finally achieve the vibrant, glowing skin you’ve always wanted.

As one of the first functional medicine telehealth clinics in the world, we provide webcam health consultations for people around the globe.

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