Last Updated on August 16th, 2020
By Dr. Jaggi Rao, MD, FRCPC, Double board-certified dermatologist
Thousands of so-called experts tell us that the way to fight acne is to strengthen the immune system. The immune system, however, is what causes the skin inflammation that manifests itself as acne. Acne bacteria only pull the trigger. The immune system is the gun. 🔫 And understanding what “turns off” the immune system can go a long way in helping you control your acne for good.
Article Table of Contents
Acne bacteria are not evil creatures whose only purpose in life is to make zits on your skin. Acne bacteria in small numbers are actually essential for healthy skin. The Propionibacterium acnes bacteria that live in your pores transform insoluble oils in the skin into propanoic acid, which is easily rinsed away with water.
As these bacteria consume excess skin oils as food, they also release beneficial essential fatty acids that reduce inflammation in the skin. The same essential fatty acids that nourish the skin, however, kill bacteria, so the skin is normally home to only as many acne bacteria as are beneficial to the skin. The mixture of water excreted as sweat and propanoic acid carries both excess bacteria and excess oil to the surface of the skin.
Acne becomes a problem when acne bacteria get trapped in a pore. Usually this happens when dead skin cells clump together on top of acne bacteria and the oil they eat as food. The bacteria run out of food. They don’t start eating human skin. As they slow down because they are hungry, 🥩🍴 they release chemicals that sensitize skin cells to inflammatory compounds released by the immune system. These compounds can break up dead skin that is holding the bacteria in place, but they can also kill healthy skin cells.
Just how much inflammation is released by the immune system in the skin depends on several factors that are not related to bacteria. The more the whole body is stressed, the more stress hormones from the adrenal glands stimulate the release of histamine (the chemical that also causes allergic reactions) and leukotrienes in the skin.
The more the skin is stressed, the more its own stress hormones stimulate the release of histamine and leukotreines in itself.
Acne bacteria just redirect the immune system’s “missiles” to the skin itself. They themselves cause very little inflammation. But when the bacteria are killed, the immune system stops destroying skin.
Most of the time, acne is self-limiting. Even if you don’t do anything, eventually the immune system decides it does not need to keep destroying healthy skin.
Other bacteria can train the immune system not to over-react in the skin. Probiotics in the colon trigger an immune reaction, too, but because the passage of waste is constantly removing them, the immune system gets used to fighting bacterial infection with less force. Eating yogurt with live cultures and taking probiotic supplements can reduce the severity of immune system reactions in your skin (and also in your brain).
The way the process goes wrong is usually human intervention. 🧍🏻♂️🧍🏼♀️🧍🏾♂️🧍🏿♀️ Squeezing a pimple, for instance, forces some of the acne bacteria deeper into the skin. They go into a layer of skin that ordinarily just waits in reserve to heal the skin when there is a cut or a scrape. These skin cells, unfortunately, can also be made more sensitive to the immune system. The bacteria are pressed so far into the skin that they don’t have an escape route, so the skin just becomes more and more inflamed around a nodule or a cyst.
Zapping zits with irritating chemicals can cause problems, too. Benzoyl peroxide usually causes only minor side effects, but stronger antiseptics like chlorhexidine can kill as many skin cells as bacterial cells. The skin has to repair itself. The irritation activates collagen-making cells in the “epidermal appendages” that provide a kind of natural bandage for the skin. This collagen forms scar tissue, either holding the skin down or pushing the skin up. The scar tissue will remain on the surface of the skin, constantly renewing itself like normal skin, until the “epidermal appendages” are activated again. This can make the scar even worse, although in dermabrasion, it can finally replace the scar with smooth and healthy skin.
All of this happens because the immune system is overstimulated.
✔️ The most important thing anyone with acne can do to keep their immune system from destroying their skin is to treat their skin gently. The fewer irritant chemicals are applied to the skin, the less it is stressed, and the less skin tissue is destroyed by inflammation.
The second most important thing anyone can do to keep their immune system from destroying their skin is avoiding stress. Stress at the whole-body level and stress in the skin itself both increase susceptibility to inflammation.
You can reduce stress at the whole-body level by avoiding emotional drama, getting enough sleep, and minimizing your consumption of caffeine.
You can reduce stress at the skin level by avoiding heat treatments, ice treatments, sudden changes of temperature on your skin, and by never putting anything on your skin that makes it tingle. Tingly sensations are not a sign your skin is being cleansed. Tingly sensations are always a sign that your immune system is killing skin cells that have been damaged by chemicals.
You can also treat your skin with substances that “calm” the skin, such as certain natural spring waters rich in magnesium and selenium. And you can make sure you cleanse any irritating substances off your skin at least once a day 📆 as part of a program of comprehensive acne care.
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