What is the pathogenesis of acne?

Abstract

For a long time, the mantra of acne pathogenesis debates has been that acne vulgaris lesions develop when (supposedly largely androgen-mediated) increased sebum production, ductal hypercornification, and propionibacteria come together with local inflammatory process in the unlucky affected individual. And yet, the exact sequence, precise interdependence, and choreography of pathogenic events in acne, especially the 'match that lights the fire' have remained surprisingly unclear, despite the venerable tradition of acne research over the past century. However, exciting recent progress in this--conceptually long somewhat stagnant, yet clinically, psychologically, and socioeconomically highly relevant--everyday battlefield of skin pathology encourages one to critically revisit conventional concepts of acne pathogenesis. Also, this provides a good opportunity for defining more sharply key open questions and intriguing acne characteristics whose underlying biological basis has far too long remained uninvestigated, and to emphasize promising new acne research avenues off-the-beaten-track--in the hope of promoting the corresponding development of innovative strategies for acne management.

Genome-wide association study identifies three novel susceptibility loci for severe Acne vulgaris

“…Keratinocyte hyperproliferation, which may lead to follicular obstruction and comedo formation in acne 19,20 , is inhibited by TGFb 21,22 . Likewise, TGFb decreases sebaceous gland lipid production 23 which is increased and altered in acne 24,25 . Finally, innate immune responses, elicited during microbial colonization by P. acnes 26,27 , may be modulated by TGFb 28 .…”

“…Of interest, the identification of SELL, encoding the leukocyte migration protein selectin L 34 ARTICLE processes. Both systems are thought to be critical in acne pathophysiology 25,35 . In summary, we report genome-wide significant associations at three independent genomic loci.…”

Studying the genetic predisposing factors in the pathogenesis of acne vulgaris

“…Acne is a common and clinically well-characterized skin disease that affects a large percentage of the general population [1]. It is a complex condition in which several factors have been implicated, including hormonal effects, an abnormal keratinocyte function, and microbial components, such as hypercolonization of the skin follicles by the bacterium Propionibacterium acnes [2].…”

“…The individual genetic background of those affected has long been suggested to play an important role in the disease pathogenesis, but because of the polygenic character little is known about the exact nature of these factors. All these factors, however, still cannot thoroughly explain the extremely high prevalence rate of this common skin disease that can be observed in Westernized countries [1]; thus, the role of environmental and individual lifestyle factors is becoming more and more appreciated in the pathogenesis of acne.…”

The experience in the use of topical retinoids and azelaic acid in therapy of acne

“…Эффективное ле-чение предусматривает учет индивидуальных осо-бенностей пациента (психосоциальный статус), ге-нетическую предрасположенность, детородный ста-тус, выраженность, тяжесть и продолжительность заболевания, ответ на предыдущую терапию, пред-расположенность к рубцеванию и поствоспалитель-ной пигментации, потенциал к побочным действи-ям, предпочтения самих пациентов и финансовую составляющую [1,5]. Опираясь на международные и отечественные рекомендации относительно патоге-неза акне, основными звеньями которого являются повышенная активность сальных желез, нарушение ороговения и развитие воспалительной реакции, значимыми направлениями терапевтической кор-рекции акне являются подавление комедоногенеза и коррекция фолликулярного гиперкератоза [6,7]. Предпочтение в этом случае отдается топическим ретиноидам, которые воздействуют на процессы дифференцирования фолликулярного эпителия, тормозят пролиферацию себоцитов, угнетают про-дукцию кожного сала и уменьшают воспалительные явления [7,8].…”