Alternatvista, your article says nothing about what starts the inflammation cycle. Without androgenic action on the pilosebaceous unit, the necessary events for the inflammation specifically in the pore that create the acne pustule cannot take place. You do not have to have "oily" skin to have just enough androgenic action to start the cycle which does result in inflammation near the end of the chain. Many people with seemingly dry skin on the surface still get blockages underneath the skin in cyst-like form. Have you ever had a stage four acne cyst excavated by a doctor? I have. Guess what, there is always a sebum pore blockage deep in the skin. Yet I have "dry" skin on the surface.
There are cysts that do not have a pore blockage. But definitions are important. What differentiates acne from similar skin conditions is the pore blockage. If there is no pore blockage, then it's not acne you're not looking at.
If you could possibly have ZERO androgenic action and ZERO sebum production, then you would not get acne. However even people with dry skin do not have zero androgens and nor do they have zero sebum. EVERY adult out there has some sebum. You don't need a lot to create the pore blockage that leads to an acne pustule.
This is why acne does start during and/or after puberty, because once puberty activates the hormones those hormones never completely go away, and typically you will always have more hormones after puberty than before. So you're way more likely as a 40 year old to have acne than a 4 year old purely based on your hormonal levels.
Tons of hormonal changes also occur later in life even if you live a great healthy stress-free life. Menopause is just one great example. In some women, the testosterone/estrogen ratio is altered in favor of testosterone. This can even happen in perimenopause. No wonder some middle aged women start getting acne out of the blue.
Also a huge point is that you are affecting your hormones every day by your lifestyle and what you eat. You may think it's all about inflammation, and it partially is. But you are modifying your hormones (including insulin/glucose) with every "anti-inflammatory" step you take. To say that it's initiated by inflammation is somewhat disingenuous as you can be as inflamed as you want, but if you had zero androgenic action and zero sebum you simply could not form the pore blockage that leads to acne. We can shut down the acne cycle much quicker by changing the hormones (major: insulin, minor: testosterone) than trying to address all the modalities of skin inflammation that are preceded by hormonal events. As most traditional acne treatments are either anti-bacterial or anti-inflammatory, certainly inflammation is a key step. But if your anti-inflammatory treatments are in no way affecting the internal hormonal events (e.g. something like benzoyl peroxide), your chances of eliminating acne are slim at best. Of course if you can do BOTH, more power to everyone.
You highlighted stress. Even the most stressed out four year old does not have acne. I have worked with many troubled kids with terrible lives, mental disorders, high amounts of stress, abuse. They don't have pustular acne in the prepubescent stage. The whole cascade of hormones simply aren't in place for the particular type of acne to develop. Studies of girls that were considered premenarchial still showed hormone changes that indicated internal puberty changes before the other visible changes came about. There was one study that said that acne can precede other signs of puberty such as pubic hair and breast development--they determined puberty had happened by measuring hormone levels.
That said, I also feel that we are agreeing in some ways but describing the problem differently. Even stress is largely a hormonally involved event. Maybe if we really really stressed out a four year old and gave them full blown type 2 diabetes (insulin problems) and stimulated androgens through weight lifting and dairy consumption, we could cause acne without the markers for puberty necessarily being in place. But to say that's happening because of inflammation only without the help of hormones is a bit silly.
I'm also curious if you even personally have acne as traditionally defined, as you seem to report "reactions" from time to time that do not sound like acne at all. For example, how was your MSM-induced acne different from your typical acne? Do you truly think the MSM-induced "acne" was even acne?
I don't think it's all about inflammation and of course hormones are involved and you are affecting your hormones with diet. I don't know why you are telling me this. I've only said so a million times.
And I don't believe the MSM issue was true acne just like I don't believe my cystic acne caused by a delayed response to a food is true acne. Also wonder if the breakouts some women experience with their menstual cycle is true acne. By true acne I mean the process they tell us takes weeks to occur