SummaryThere are four central factors that contribute to acne physiopathology: the inflammatory response, colonization with Propionibacterium acnes, increased sebum production and hypercornification of the pilosebaceous duct. In addition, research in the areas of diet and nutrition, genetics and oxidative stress is also yielding some interesting insights into the development of acne. In this paper we review some of the most recent research and novel concepts revealed in this work, which has been published by researchers from diverse academic disciplines including dermatology, immunology, microbiology and endocrinology. We discuss the implications of their findings (particularly in terms of opportunities to develop new therapies), highlight interrelationships between these novel factors that could contribute to the pathology of acne, and indicate where gaps in our understanding still exist.Acne vulgaris is a near universal cutaneous inflammatory disease affecting more than 85% of adolescents worldwide.
1,2While not a fatal disease, acne can persist throughout life and leave permanent scarring on the face as a result. Four distinct processes are believed to play critical roles in the formation of acne lesions: alteration of keratinization processes, leading to comedo formation; follicular colonization by Propionibacterium acnes; increased sebum production and inflammatory mediators around pilosebaceous units. [3][4][5] Several medications that have been devised to target these pathogenic mechanisms have demonstrated modest efficacy, but their use is also accompanied by potentially serious side-effects.6,7The exact sequence of events and how they are interconnected is still unknown, due to the inherent complexity of this disease. Ongoing research is modifying the classical view of acne pathogenesis through identification of underlying mechanisms for previous theories and experimental findings. Recently, researchers from diverse academic disciplines including dermatology, immunology, microbiology and endocrinology have reported novel concepts for acne physiopathology by employing cutting-edge experimental methods and academic approaches.The four central factors that contribute to acne physiopathology are inflammation, colonization with P. acnes, increased sebum production and hypercornification of the pilosebaceous duct. Recent research suggests that these factors are much more interrelated than has been previously understood. Novel factors that could contribute to acne physiopathology include inflammasomes, T helper (Th)17 cell immunology, P. acnes sequence type and nutritional factors.In this article we review the most recent findings in acne physiopathology. We focus on specific issues associated with each of the four pathogenic factors, as well as some additional interesting research pathways, which may provide novel frameworks for improving our understanding of the disease pathogenesis and development of new medications. Finally, we provide a brief outlook of the prospects for this intriguing field of dermatolo...