Excess vitamin B12 is another potential trigger for inflammatory-type acne. Briefly, when P. Acnes bacteria has more vitamin B12 it needs, it produces more porphyrins; inflammatory substances that have been shown to cause the type of damage to fatty acids in sebum that triggers the acne formation process. When the bacteria don’t have enough B12, they use their energy to make it.
How much is too much? Nobody knows yet. This is likely to be a problem only when supplementing with megadoses. The RDA for B12 is 2.4 mcg/day. Most B12 supplements contain 500 to 1000 mcg per serving and call for two to three servings a day.
Anyway, the point is that B12 is a potential trigger. If you currently take B12 supplements or vegan alternatives like spirulina, then try cutting those out for 3 to 6 weeks and see what happens.
For more detailed discussion of this, please see this blog post: Warning: Study Shows Common Vitamin Supplement Causes Acne.
Dental problems are another potential source of inflammatory bacterial toxins. A 2013 review of causes of inflammation and endotoxemia has this to say.
Studies have shown that individuals with severe periodontitis have elevated serum levels of LPS. The persistent nature of periodontal disease and bacterial colonization make for conditions that would allow for the shedding of bacterial into circulation to occur consistently for a long period of time.
Glaros, T. G. et al. Causes and consequences of low grade endotoxemia and inflammatory diseases. Front Biosci (Schol Ed) 5, 754–65 (2013). https://www.ncbi.nlm.nih.gov/pubmed/23277084
Earlier we discussed how lipopolysaccharides (LPS) are one source of acne-causing inflammation. Like the ones in the gut, the bacteria causing dental problems also contain LPS. The toxins can easily leak into systemic circulation.
If this sounds far-fetched, consider that the American Heart Association in 2012 published a scientific statement after reviewing all the relevant studies. They concluded that dental problems are linked to heart disease, possibly because dental issues are known to increase systemic inflammation. They also stated that there’s evidence to show treating dental problems reduces systemic inflammation.
In all fairness, they also said that we don’t have enough evidence to conclude that dental problems would cause heart disease. Mainly because we don’t have enough studies that look at inflammation and heart disease risk factors before and after dental treatment.