Bottomline: Acne is an inflammation disorder involving omega-6 fats. Background: Acne is more than an awkward right of passage for teens and the hormonally-challenged (think menopause), it is an inflammation disorder of the skin, which involves the same inflammatory compounds triggered by asthma, clogged arteries and possibly breast cancer.  It was not that long ago that scientists started to explore the role of omega-6 fats and their inflammatory compounds in acne.  It was only in 2005 that researchers (Iwata), examined the sebaceous gland—the cornerstone of acne folly, in hamsters (hard to imagine) and identified the presence omega-6 fat compounds.

First Human Study
One year later, in 2006, a researcher team (Alestas) compared the skin cells of healthy people with those afflicted with acne. The  acne group,had two different areas of skin cells evaluated--one section from the outbreak area and the other cells were from an uninvolved area of their skin.

The findings were profound—as it was the first acne study to identify several omega-6 fat compounds that worsen inflammation in humans.  They also found key enzymes, which turn omega-6 fat into potent incendiary compounds in the skin.

Look at the picture below, which compares the skin cells of healthy people with skin cells of people afflicted with acne. You don’t need to be a scientist to see the startlingly difference--the red color shows inflammation with the 5-LOX enzyme present. 

The redness reflects the amount of a key enzyme, 5-LOX, which turns the omega-6 fat, arachidonic acid, into potent leukotrienes, a group of inflammatory compounds associated with breast cancer, heart disease and asthma.  (See these links for more detail):

•  Asthma Triggering Compounds from Omega-6 Fat Create Clogged Arteries, 

• Arachidonic Acid Gone Awry—Increases Risk of Heart Attack

The Asthma-Acne Link 
Interestingly, in 2005 doctors reported a case study in which a 40-year old woman with acne was treated successfully with the asthma medication, Zileuton, which is a leukotrienes-inhibitor.   But when she stopped using the medication her skin problem resumed.

Many of the active ingredients in topical acne and blemish creams and medications work by blocking the inflammatory effects of omega-6 fats (Mackowiak).  For example, salicylic acid, a form of aspirin, works by blocking the COX enzymes, which prevents omega-6 fats from churning out inflammatory compounds (these enzymes are also elevated in people with acne).

Hunter-Gatherers--No Such Thing as Acne

“Not a single papule, pustule, or open comedone was observed in the entire population examined.”

Acne and chronic inflammatory diseases, like stroke and heart attacks, were nonexistent in hunter-gather tribes (Cordain).  Yet the incidence of acne in westernized countries reaches over 95% over a person's lifetime.  It is our diets that have dramatically changed over the last century—we eat foods that increase inflammation in our bodies. 

Omega-6 Fat Diet Connection
The more omega-6 fats in your diet, the more inflammatory arsenal lines your cells, whether it’s the cells of your skin or lungs.  Dietary omega-6 and omega-3 fats compete for limited seating in the cells.  Whichever fat is in most abundant supply in your diet, gets the coveted cellular seat, like competition for open seating at a sold-out concert. 

In the case of the American diet, omega-6 fat “wins” a great majority of the cell's selective seating, as part of a phospholipid, which means more fuel for inflammation.   No culture has ever been exposed to the current high levels of omega-6 fat in the diet, in part because it wasn’t possible 100 years ago, before technology. 

Our ancestors ate a diet of equal proportions of omega-6 and omega-3 fats.  Today, that balance is out of whack--omega-6 fats outnumber omega-3 fats by 10 to 20-fold.  Omega-6 fats are the most common polyunsaturated fat eaten.

The top sources of omega-6s are soybean oil, corn oil, vegetable oil and cottonseed oil, which are chief ingredients in margarine, salad dressings, mayonnaise, processed foods and many so-called "heart-healthy" foods.  For more information see
Links to Sources:
Alestas T, Ganceviciene R, Fimmel S, Müller-Decker K, Zouboulis CC.
 Enzymes involved in the biosynthesis of leukotriene B4 and prostaglandin E2 are active in sebaceous glands.
J Mol Med. 2006 Jan;84(1):75-87. Epub 2005 Dec 31.

Cordain, L.  et al. 
Acne Vulgaris: A Disease of Western Civilization. 
Archives of Dermatology, 2002;138:1584-1590. FREE FULL TEXT

Iwata C, Noriko Akimoto1, Takashi Sato, Yuki Morokuma and Akira Ito
Augmentation of Lipogenesis by 15-Deoxy-[Delta]12,14-Prostaglandin J2 in Hamster Sebaceous Glands: Identification of Cytochrome P-450-mediated 15-Deoxy-[Delta]12,14-Prostaglandin J2 Production.
J Investig Dermatol (25 Oct 2005)125 (5):865-72 FREE FULL TEXT.

Logan A.C. 
Linoleic and linolenic acids and acne vulgaris
British Journal of Dermatology (2008)Volume 158, Issue 1:201–202. FREE FULL TEXT.
http://www3.interscience.wiley.com/cgi-bin/fulltext/119388273/HTMLSTART

Clinical Infectious Diseases 2000 31:s5, S154-S156. FREE FULL TEXT.

 Zhang Q et al.
Involvement of PPAR[gamma] in Oxidative Stress-Mediated Prostaglandin E2 Production in SZ95 Human Sebaceous Gland Cells,
J Invest Dermatol (2006)126 (1), 42-44.

 Zouboulis C
Sebaceous Glands and the Prostaglandin Pathway--Key Stones of an Exciting Mosaic

J Investig Dermatol (Nov 2005)125 (5), FREE FULL TEXT.
http://www.nature.com/jid/journal/v125/n5/abs/5603596a.html

 Zouboulis CC, Jens Malte  Baron, Markus  Böhm , Stefan  Kippenberger, Hjalmar  Kurzen, Jörg  Reichrath  and Anja  Thielitz.
 Frontiers in sebaceous gland biology and pathology
Experimental Dermatology (2008)Volume 17( 6):542–551 FREE FULL TEXT

Zouboulis ChC, Saborowski A, Boschnakow A.
Zileuton, an oral 5-lipoxygenase inhibitor, directly reduces sebum production.
Dermatology. 2005;210(1):36-8.
 

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