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Acne and Inflammation
Inflammation is a major component of acne. It is responsible for 4 out of the 6 lesions that are associated with the skin disease. Read on to find how acne inflammation occurs, what causes it and how to treat it.
by Brad Chase
Inflammation is one of the main components of acne. It is responsible for all the non-comedone bumps on the skin during acne breakout.
Most people experience their first acne breakouts during puberty. Although there is no cure for acne, it can be well managed with the right treatment. Acne lesions usually clear away as adolescents become young adults but for some people acne persists long into adulthood.
There are two types of acne lesions: inflammatory and non-inflammatory acne lesions.
Non-inflammatory acne lesions include blackheads, whiteheads and milia.
Inflammatory acne lesions are also divided into two groups: superficial lesions and deep lesions. Superficial inflammatory acne lesions include papules and pustules while deep inflammatory acne lesions are nodules and cysts.
A number of factors can cause acne. These include diet, stress, genetics, hormones and bacterial infections. All of these factors can cause and/or worsen acne inflammation.
Diet, stress and genetics only cause acne through the last two factors.
Not all foods cause acne. Those that do cause acne include milk, dairy products and foods with high glycemic loads. These foods introduce or increase the production of certain hormones in the body.
Stress can also cause acne through the hormonal link and so can genetics.
The hormones implicated in inflammatory acne include androgens such as testosterone and dihydrotestosterone; and insulin-like growth factor 1 (IGF-1).
The 4 inflammatory acne lesions are discussed below:
Papules: Papules are small, inflamed, red, tender bumps on the skin. They have no heads and should not be popped. When aggravated, papules can worsen and turn into deep inflammatory lesions such as papules.
Pustules: Pustules are similar to papules but they have heads and white or yellow centers. They are commonly called zits. Pustules are filled with pus which is made up of white blood cells. They can be popped but only with care as aggravating them can spread bacterial infections and proinflammatory factors deep into the dermis.
Nodules: Nodules are larger than papules and pustules. They are large, hard bumps pushing up the top layer of the skin. Nodules are painful and they last longer. They can cause acne scars and/or go dormant for while only to flare up repeatedly. Nodules should not be squeezed.
Cysts: Cysts are like nodules but they are filled with pus. They are also painful and can cause acne scars. When aggravated, cysts can cause deep tissue infections and extensive inflammation in the dermis.
Inflammation is a major component of the biological response of tissues to damage from pathogens, toxins, antigens and irritants. Inflammation is also necessary for tissue repair to proceed and it is a means by which the body protects itself against further damage.
Inflammation is not the same as infection. While infection is caused by microbes, inflammation is caused by the immune system and it is a response to infection.
However, inflammation is a general response to harm.
Unlike an adaptive immune response that is tailored to the specific harm done, inflammation is classified under innate immunity. Therefore, it is much like an undirected solution to different problems.
For this reason, the body closely regulates inflammation. Still, harmful stimuli can set off a cycle of inflammation by exploiting the body’s knee-jerk response of sending inflammatory immune cells to the site of injury.
Inflammation can either be acute or chronic.
Acute inflammation is a quick response to harmful stimuli. It is a generic response from the immune system and it is usually achieved by sending leukocytes and moving plasma to the site of injury.
Chronic inflammation, on the other hand, is sustained inflammation that stays longer than acute inflammation. It involves specific immune cells which damage and heal the tissues at the sites of injury.
At the start of acne inflammation, the immune cells already present in the tissues of the skin initiate the inflammatory response. These cells include dendritic cells, macrophages, mastocytes and histocytes.
These cells recognize the bacteria causing the inflammation and then release inflammatory mediators such as leukotrienes and bradykinin. They also cause vasodilation so that there is increased blood flow to the site of injury.
This causes the redness that marks inflammatory acne lesions.
The local immune cells also increase the permeability of the local blood vessels. This allows the leakage of plasma proteins, neutrophils and fluids into the tissue.
This causes the swelling on the skin that is observed as raised bumps of acne lesions.
Finally, secreted mediators such as bradykinin increase the sensitivity of the surrounding tissues to pain. This explains why nodules and cysts are painful inflammatory acne structures.
However, the released mediators are only short-lived and need to be constantly replenished.
During acne breakout, the bacteria causing the tissue damage must be wiped out before the body can stop producing these mediators. Therefore, by treating bacteria acne, inflammation can be reduced.
Alternatively, anti-inflammatory drugs may be used to directly reduce the extent of the swelling.
The first step in the appearance of acne on the skin is the increased production of androgens and other acne-causing hormones such as IGF-1.
Androgens bind to androgen receptors found on the cells of the sebaceous glands. These hormones then increase the production of new sebocytes and, by doing this, they cause the enlargement of the sebaceous glands and then the increased production of sebum.
The secretion of excess sebum increases the population and changes the nature of acne-causing bacteria such as Propionibacterium acnes.
Although, it is usually a commensal, P. acnes turns virulent under the right conditions.
Excess sebum creates the ideal growth environment for P. acnes. Since this bacterium is an anaerobe, it colonizes the anaerobic and microaerobic environments of the follicular ducts in the skin. Therefore, as excess sebum is being pushed to the surface, it traps a harmful mixture of dead skin cells and bacteria in the skin pores.
While this blockage leads to the formation of acne comedones such as whiteheads and blackheads, it is the growing bacterial infection in the pores that causes inflammation.
The body then responds to the damage caused by P. acnes and other acne-causing bacteria.
This first response is the activation of immune cells such as neutrophils and bradykinin. The response also causes the leakage of plasma proteins and white blood cells from blood vessels into the surrounding tissue.
This gives rise to the pus filling inflammatory acne lesions such as pustules and cysts.
However, P. acnes resists the white blood cells sent after it. It resists destruction by phagocytosis and it can survive inside macrophages for a long while.
Furthermore, P. acnes secretes enzymes such as lipases which break down sebum to proinflammatory lipids such as free fatty acids and proteases which break down neutrophils and other immune cells.
Also, P. acnes releases antigens which then prompts the body to release specific antibodies such as CD4+ T-cells, IL-alpha (interleukin alpha) and TNF-alpha (tissue necrosis factor alpha).
Mild acne inflammation can be treated with a combination of good skin care regimen, over-the-counter topical acne creams, oral skincare supplements as well as natural herbal remedies.
However, in cases of severe inflammation, stronger medications may be needed to control the spread of inflammatory acne lesions.
First, wash your skin regularly with antibacterial washes and cleansers. These topical OTC acne products usually contain such anti-acne active ingredients like salicylic acid and benzoyl peroxide.
These OTC products not only provide deep cleansing and exfoliating action but they can also stop bacterial growth on the skin. They may cause the skin to dry out.
Therefore, oil-free moisturizers are recommended for those with dry or sensitive skin types.
Inflammatory acne can also be treated with foods both by the ones you exclude and the ones you include in your diet.
To reduce acne inflammation, drop milk, milk products and sugary drinks and snacks from your diet. Also include fruits and vegetables in your diet. Most of these contain anti-inflammatory and antioxidant phytochemicals which can both protect the skin and reduce inflammation.
Foods rich in Omega-3 fatty acids are also excellent choices. These include fatty fishes and fish oils.
Herbal extracts are also excellent anti-inflammatory remedies. They are effective and safe to use. Examples of herbs to consider for reducing acne inflammation are witch hazel, licorice root, burdock root, gum guggul, ginger, turmeric and boswellia.
Some minerals and vitamins also have anti-inflammatory properties. These include vitamins A and E as well as zinc. The vitamins are potent antioxidants too while zinc has a strong antibacterial property.
Consider treating your inflammatory acne with an oral supplement that includes different herbal extracts, vitamins and minerals. A good example of such acne supplements, which are also effective for reducing inflammation, is Actimine.
There are different drugs that can be used to treat inflammatory acne. To reduce the actual inflammation, oral but especially injectable corticosteroids are used.
Prednisone is a prime example of oral corticosteroid that works but cortisone shots can also be delivered directly to inflammatory lesions in cases of severe acne.
Antibiotics can also be used for treating inflammatory acne.
They work by killing off the acne-causing bacteria triggering the inflammatory response. Antibiotics can be taken topically (clindamycin and erythromycin) and orally (erythromycin and the tetracycline antibiotics).
To go even further back in the chain of causative agents, anti-androgens such as spironolactone and estrogen/progestin contraceptives can be used to treat inflammatory acne. They prevent androgens from stimulating the sebaceous glands and so prevent the production of the excess sebum needed for the rapid growth of acne-causing bacteria.
Retinoids are also effective for inflammatory acne. There are two kinds: oral retinoids and topical retinoids.
Oral retinoids such as isotretinoin (Accutane) are the last resort in the treatment of acne. They produce some very serious side effects and are only recommended when all other treatment options fail.
Topical retinoids such as adapalene are however milder and safer. These retinoids are synthetic vitamin A analogs. They reduce the production of sebum and also the rate at which dead skin cells are produced.
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