Pathogenesis of acne.

Abstract

Abstract The rate of sebum excretion was measured in individuals who had acne, who had had acne, or who had never had acne. In males over ten and females over fifteen with no present or past acne, sebum excretion increased until the third to fourth decade and then decreased, the rate of decrease being similar in both sexes. The rate of sebum excretion was greater in females aged ten to fifteen years than in males of the same age but was greater in all other age-groups in the males. The rate of sebum excretion in females was greater at age ten to fifteen years than at age sixteen to twenty; this contrasts with the findings in males. This can be explained if (1) the onset of puberty was earlier in females; (2) seborrhoea precedes clinical acne. Patients with acne had seborrhœa, and the severity of the clinical acne was directly related to the rate of sebum excretion. The sex difference in sebum secretion was less in patients with acne than in the controls without acne. In healthy individuals who had had acne there was a persistently increased rate of sebum excretion, and the difference in sebum-excretion rate between males and females was less striking than in the control population who had never had acne. It is concluded that acne is due to the interaction between an increased rate of sebum secretion and a second factor (increased resistance to sebum flow from organic obstruction or increased sebum viscosity). A rational experimental approach to the treatment of acne is therefore by reduction of sebum secretion by an antiandrogen or metabolic inhibitor, or by decreasing resistance to sebum flow (e.g., by reducing its viscosity).