With the night-and-day change in my redness score and my positive physical results, I wondered if I was seeing Dr. Sung’s theory— that cellular inflammation impacts acne—play out in real time. And I wondered why the role of inflammation in acne was not discussed with patients like myself more often.
There’s so much focus on inflammation in general medical research now, and conversations around inflammation have even entered the mainstream, thanks to news reports and social media. For years, experts thought chronic inflammation was a consequence of various illnesses, but there is strong evidence that in some cases, inflammation itself can actually lead to disease. Some levels of inflammation are good and necessary for the body, such as healing wounds. Still, when your body is in a constant or chronic inflammation state, it can lead to various health problems because your immune system is constantly in attack mode, according to the Cleveland Clinic.
“What happens with acne is that the inflammation is not happening in a vacuum. It’s happening in the context of other changes that also have to be present to create a pimple or a breakout,” says Dr. Garshick. These changes could be a result of your climate, diet, or menstrual cycle, among other factors.
“It is thought that some people who have certain inflammatory conditions like ulcerative colitis or Crohn’s disease may be more likely to have inflammatory acne because we know their body is somewhat more revved up,” she adds. However, she cautions that the dermatological community has not thoroughly investigated or confirmed the relationship between diagnosable inflammatory conditions and inflammatory or cystic acne.
Typically, acne is classified as non-inflammatory and inflammatory, says Dr. Garshick, explaining that non-inflammatory acne typically consists of white and blackheads, while inflammatory acne is deep, sometimes painful, nodules and cysts. However, according to Emil A. Tanghetti, MD, a board-certified dermatologist in Sacramento, California, non-inflammatory acne is a misnomer. That’s because inflammation is present at all stages of acne development, perhaps even before the actual pimple appears.
Acne is complex, and there is not always a clear cause and effect. It’s that inability to pin down one precise cause that makes acne so challenging to treat. “Adult female acne is always the most difficult,” said Dr. Tanghetti. “It’s hormonally driven, and it’s hard to address that component of acne.” According to the Yale School of Medicine, approximately 50% of women in their 20s, 33% of women in their 30s, and 25% of women in their 40s experience acne.