An increase in normetanephrine in hair follicles of acne lesions through the sympatho‐adrenal medullary system in acne patients with anxiety

Abstract

Acne vulgaris is a chronic inflammatory disease in the pilosebaceous units where excess sebum secretion, epithelial hyperproliferation, Cutibacterium acnes proliferation, and innate and adaptive immunity dysregulation occur, resulting in the appearance of comedones, papules, pustules, and scars of the skin. 1 The development of acne has been associated with intrinsic and extrinsic factors, e.g. androgen, inflammatory cytokines, smoking, and ultraviolet irradiation. Furthermore, recent studies have reported that psychological stress, such as anxiety and depression, is associated with the onset and aggravation of acne with a significant impact on quality of life in patients. 2,3 Psychological stress causes the activation of the endocrine and nervous systems. The former is the hypothalamic-pituitary-adrenal (HPA) axis, which is involved in cortisol release from the adrenal