Pathogenesis of Acne

Acne Vulgaris results due to four main factors.

1.Blockage of sebaceous follicles.

2. The epithelial cells in sebaceous follicles under go abnormal desquamation (shedding of the skin). Comedogenesis is the obstruction of sebaceous follicles due to greater cohesiveness of the follicular epithelial cells and sebum.

3. The anaerobic, commensual bacterium Propionibacterium acnes proliferates in a lipid rich environment.

4. P acnes produces proinflammatory mediators that cause midrocomedones to inflame and become papules, pustules, and nodulocystic lesions. Another factor, excessive sebum production is caused by androgenic stimulation of sebaceous glands.

The Role of Sebum

An increase in sebum is a direct result of increased production of adrenal and gonadal androgens (which occurs during the onset of puberty).