Comedogenesis: Some Aetiological, Clinical and Therapeutic Strategies

Abstract

Hypercornification is an early feature of acne and usually precedes inflammation. It is associated with ductal hyperproliferation, and there are many controlling factors such as androgens, retinoids, sebum composition and cytokines. Cycling of normal follicles and of comedones may explain the natural resolution of comedones and, in the longer term, resolution of the disease itself. There is a need to tailor treatment according to comedonal type. Suboptimal therapy can often result from inappropriate assessments of comedones, especially microcomedones, sandpaper comedones, submarine comedones and macrocomedones. Macrocomedones can produce devastating acne flares, particularly if patients are inappropriately prescribed oral isotretinoin. Gentle cautery under topical local anaesthesia is a useful therapy in the treatment of such lesions. The newer retinoids and new formulations of all-trans-retinoic acid show a better benefit/risk ratio.

Biochemical markers of psoriasis as a metabolic disease

“…It also induces antibacterial features of neutrophils. Apart from that, IL-8 induces angiogenesis and influences other cells, which take part in inflammatory response including: T lymphocytes, natural killer cells (NK) and basophils, and it is also chemotactic towards keratinocytes [112,120,121].…”

Psikonöroimmünoloji ve Multifaktöryel Psikodermatolojik Hastalıklar

“…Periferik sinirlerden salg›lanan SP'nin sebase glandlar›n proliferasyonunu stimüle etti¤i ve sebase hücreler-de lipit sentezini artt›rd›¤› son zamanlarda gösterilmifltir. SP d›-fl›nda β-endorfin, VIP, NPY, CGRP'nin ve opioidlerden MSH α'n›n sebositlerdeki yang›sal sitokinleri, hücre ço¤almas›n›, farkl›laflmas›n›, lipogenez ve androjen metabolizmas›n› düzen-ledi¤i ileri sürülmüfltür [37][38][39] . 1960'l› y›llardan itibaren strese ba¤l› klinik alevlenmeler baz› otörler taraf›ndan gözlenmeye bafllanm›flt›r 40,41 .…”

Fatores etiopatogênicos da acne vulgar

“…33,34 O ácido linoléico, necessário para a síntese de ácidos graxos de cadeia longa ω-6 35 e cuja deficiência em animais acarreta descamação, está reduzido nos comedões. 36 Sendo um ácido graxo essencial, o ácido linoléico tem importante papel na manutenção da função de barreira epidérmica, modulação do metabolismo eicosanóicoe e dos sinais celulares. 7 Alteração na barreira epidérmica facilita a penetração na derme de organismos e ácidos graxos pró-inflamatórios presentes no sebo, promovendo infecção e inflamação.…”