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Aetiology of acne


The four major factors involved in the aetiology of acne are: 1 Seborrhoea 2 Comedo formation (comedogenesis) 3 Colonization of the intrafollicular duct with P. acnes 4 Inflammation. The most obvious function of the sebaceous glands is to produce sebum and excess sebum production is a prerequisite for the development of acne [1] . The level of sebum secretion correlates reasonably well with the severity of the acne ( Fig. 42.18 ) [2,3] . Fig. 42.18 Correlation between acne severity and sebum excretion. Sebaceous activity is regulated by androgens of gonadal or adrenal origin [4–6] . Androgen-insensitive subjects lack androgen receptors; they do not produce sebum and do not develop acne [5] . Systemic administration of testosterone and dehydroepiandrosterone (DHEAS) increases the size and secretion of sebaceous glands [6] . These two facts support the essential role of androgens in sebum stimulation. Clinical observations pointing to the importance of androgens in acne include the development of early acne in association with increased levels of DHEAS, a precursor of testosterone. The rise of DHEAS in prepubescent children is associated with an increase in sebum production and development of comedonal acne [7] . Androgens regulate sebaceous gland function through binding to nuclear androgen receptors (ARs) [8] . Immunohistochemistry has demonstrated that sebaceous ... log in or subscribe to read full text

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