Follicular Infundibulum Research Articles

Follicular (Infundibular-Tricholemmal) Squamous Cell Carcinoma: A New WHO Entity. Clinicopathological Features in 103 Cases, Including Follow-Up and Implications for Patient Management.

Cutaneous follicular (infundibular-tricholemmal) squamous cell carcinoma (FSCC) is a new World Health Organization entity. We present the largest series of published cases, summarizing clinical data, diagnostic criteria, differential diagnosis, and implications for patient management. Cases were identified from 2004 to 2011. Inclusion criteria included discrete attachment(s) of the tumor to the overlying epidermis via follicular infundibula, tricholemmal keratinization, and cellular pleomorphism. Keratoacanthoma and lesions with adjacent bowenoid epidermal dysplasia were excluded. One hundred three cases of FSCC identified. 48.5% demonstrated completely circumscript borders ( in situ for practical purposes), 12.6% uncertain for invasion (overwhelmingly pushing borders), and only 38.8% as clearly invasive. Follicular mucin in acantholytic spaces within tumor epithelium was a distinctive finding in 57.2% of cases. Clinical data indicated predominance in elderly (median 78.5 years) men (70.4%), with preferential head and neck location (81.6%). Many were clinically suspected as squamous cell carcinoma (48.5%). However, a significant minority were clinically diagnosed as basal cell carcinoma (40.8%). This may reflect that FSCC commonly presented as a papule or nodule (51.3%). By contrast, keratoacanthoma was less frequently suggested (17.2%) and still fewer lesions were suspected to be actinic keratosis/Bowen's disease (13.6%). Follow-up in 82 cases (median 26.5 months, range 3-144) identified 5 (6.1%) local recurrences. There was no instance of metastasis in the subgroup of lesions with completely circumscript borders. Three of 45 (6.7%) patients, with follow-up, considered to have tumors with invasive pushing, and/or infiltrative borders developed lymph node metastases. FSCC is identified as a common skin cancer, incorporating historical entities, such as infundibular carcinoma and tricholemmal carcinoma, with readily identifiable histologic features. Correct diagnosis has implications for patient management; a significant subgroup of lesions show completely circumscript borders that are considered in situ for practical purposes.

Dermatoscopic profiling of inverted follicular keratosis indifferent skin phenotypes.

Inverted follicular keratosis (IFK) is a rare benign tumour of the follicular infundibulum. Owing to its similarity to other benign and malignant cutaneous lesions, it poses a diagnostic challenge. There is limited information on the dermatoscopic characteristics of IFK and the majority of cases have been reported in patients with lighter skin types. To describe the prevalent dermatoscopic features of IFK, especially in patients with skin of colour. We retrospectively analysed 35 histopathologically verified cases of IFK from a single university hospital in Turkey. With respect to the Fitzpatrick skin phototype, 2 (6%), 12 (34%), 16 (46%) and 5 (14%) patients had Fitzpatrick skin phototypes II, III, IV and V, respectively. Clinically, the majority of IFKs were hypopigmented or nonpigmented (83%). Pink-white structureless areas (54%), ulceration (54%), a central keratin mass (43%) and blood spots on keratin mass (43%) were the most frequent dermatoscopic findings. Pigmented structures were observed as blue-grey structureless areas in 12 lesions and as blue-grey clods in 5, primarily in Fitzpatrick phototype IV and V skin. The incidence of a pink, structureless area and blood spots on ulceration was found to be statistically significantly higher in individuals with fairer skin types, while a greater prevalence of blue-grey coloration was observed in those with skin of colour (P < 0.05). Although our study found some distinguishing dermatoscopic findings in IFK, diagnosis is generally confirmed by histopathology, as the clinical appearance and dermatoscopic findings may not be sufficient to differentiate it from other tumours, especially squamous cell carcinoma or keratoacanthoma. The dermatoscopic characteristics of dark skin are comparable to those of pale skin; however, hyperpigmentation can be more noticeable in skin of colour.

Late diagnosis of Bowenoid in situ carcinoma in two cats: the importance of identifying mild and superficial lesions

Cutaneous neoplasms have a significant representation in the casuistry of neoplasms in felines, emphasizing squamous cell carcinoma and basal cell carcinoma. Thus, clinical knowledge is necessary for the correct diagnostic and curative approach to the patient. This study aimed to report two cases of late diagnosis of Bowenoid carcinoma in adult cats (&gt; one year) admitted at the Veterinary Teaching Hospital of the Federal University of Jataí in order to collaborate with the existing literature and help veterinarians in the knowledge of associated lesions. At macroscopy in the hospital admission, both cats presented lesions on the head in the bilateral supraorbital frontal region that slowly evolved into erosions and crusted ulcers with purulent exudation, in addition to lesions in the perilabial region (case 1). In microscopy, findings revealed Bowenoid carcinoma in situ. Supraorbital lesions revealed the abrupt formation of epidermal plaques, including follicular infundibulum continuous with the acanthotic epidermis with loss of normal stratification. Focal orthokeratosis and marked atypia of keratinocytes (macrokaryosis, macronucleosis, macrocytosis, anisokaryosis, and anisocytosis) were also observed. Early diagnosis through clinical analysis combined with histopathological evaluation is of fundamental importance to ensure therapeutic success, improving the patient’s prognosis, a condition not achieved in the cases presented mainly due to late diagnosis.

An unusual presentation of epidermoid cyst in an adult male in India: A case report

The epidermoid cysts are true cysts that are often found in the face and less commonly in the trunk and back of the human body. These cysts often have a predilection toward the male gender with the third and fourth decades of age group. They generally arise from the follicular infundibulum, primarily due to plugging of the follicle. Often a part of genetic syndromes, they can also be post-traumatic where the ectodermal cells get stuck or reimplanted. Epidermoid cysts are often a slow-growing and painless lesion with few exceptions. The proper neurological examination, clinical examination, and investigations such as magnetic resonance imaging help in confirming the diagnosis and proceeding with the management. Clinically, epidermoid cysts may or may not present with the neurological impairment. The preferred intervention is total or subtotal resection with minimal chances of complications such as recurrence, swelling, and infection. However, these can very well be avoided by regular follow-up assessments. The clinical presentation in the lower back with massive dimensions is relatively uncommon, and therefore, authors have presented here an unusual case from the outpatient department of neurosurgery, where the patient presented with a large, soft, exophytic lesion at the level of (S4/S5), which gave rise to the suspicion of meningocele and meningomyelocele, but after complete local assessment and radiological investigations, it was diagnosed finally as an epidermoid cyst. Keeping in mind, the clinical profile, socioemographic factors, and metabolic profile, the intervention of surgical total resection was planned, and the patient was managed.

Detection of sebaceous gland hyperplasia with dermoscopy and reflectance confocal microscopy.

Sebaceous gland hyperplasia (SGH) is a benign cutaneous proliferation of the sebaceous glands that are mostly present on the face or the neck of older adults. They typically appear as single or multiple soft umbilicated papules; however, in challenging cases, it can be difficult to distinguish them from trichoepitheliomas, base cell carcinomas, or other tumors. Although pathological results have diagnostic value, the significance of non-invasive examinations in diagnosis and differential diagnosis is also worth exploring. This study aimed to describe the dermoscopic and reflectance confocal microscopy (RCM) features of SGH. A total of 31 patients diagnosed with SGH, according to clinical and histopathological standards, were examined using dermoscopy and RCM between March 2018 and January 2022. Dermoscopically, lesions revealed a yellowish-red background and a faint-yellow background in 25 (80.65%) and six cases (19.35%), respectively. White-yellowish lobulated structures in the center of the lesion were present in 31 patients (100%) and umbilications in 19 patients (61.29%). Crown vessels at the periphery of the lesions were observed in 11 patients (35.48%), whereas irregular linear vessels were observed on the surface of the lesions in 18 patients (58.06%). Under RCM, all lesions presented a honeycomb pattern in the epidermis and the typical morulae-shaped sebaceous lobules in the dermis. A dilated follicular infundibulum was observed in 15 patients (48.39%) and dilated vessels in 26 patients (83.87%). Dermoscopy and RCM enabled us to describe the imaging features of SGH. Combining these two useful tools provides a non-invasive basis for accurate clinical diagnosis.

Pellino1 promotes immunity in the skin during infection with herpes simplex virus (HSV)

Abstract Pellino1 (Peli1) is a ubiquitin ligase involved in IL-1 and Toll-like receptor signaling; however, the role of Pellino1 in skin immunity against HSV is unknown. Here, using the mouse flank HSV-1 skin infection model, we demonstrate that Pellino1 has several critical functions during active viral replication. Analyses of single cell genome wide gene expression data (RNA-seq) revealed expression of Peli1mRNA throughout the skin including in epithelial, fibroblast and immune cells. Both histology and RNA-seq demonstrated normal development of the epidermis and dermis in Pellino1 knockout (KO) mice. The median survival of Pellino1 KO mice was 12 days compared to greater than 16 days in wild type mice. Pellino1 deficient mice also developed larger zosteriform skin lesions along affected dermatomes. During infection HSV-1 did not replicate in the dermis. Immunohistochemistry revealed delayed recruitment of myeloid and T cells to early infected epidermis in Pellino1 deficient mice. This correlated with lower expression of the inflammatory IL-1 and IL-36 cytokines and the poorly understood chemokine Grp15l. In Pellino1 KO mice, the virus spread extensively through the epidermis, follicular infundibulum into sebaceous glands where sebocytes were found positive for the virus. Histological analyses for HSV-1 and neuronal axons revealed nerve endings throughout the epidermis and axons wrapped around the hair follicles. Dissemination of HSV-1 into the sebaceous glands did not appear to involve a shift in how the virus migrated through these nerve axons as early lesions were only found in the interfollicular epidermis. In conclusion, Pellino1 plays important roles in restricting viral dissemination. Supported by grant from NIH (R01 AI125111)

Widespread and eruptive comedonal lesions with alopecia

A 68-year-old White man presented with a 2-year history of asymptomatic, widespread comedones associated with patchy alopecia of the scalp and eyebrows and total alopecia of axillary and pubic hairs (Fig 1, A to C). Histopathology of a comedonal area demonstrated a dilated, follicular infundibulum with keratotic plugging and a perifollicular band-like CD4-predominant atypical T-lymphocytic infiltrate leading to the detachment and infiltration of the follicles (Fig 1, D and E). Subsequently, erythematous, erosive plaques started to develop on the trunk and limbs of the patient (Fig 1, F), the histopathology of which showed a more extensive, diffused, epidermotropic infiltrate containing CD4-predominant T lymphocytes with sparse medium- to large-sized lymphocytes (Fig 1, G).

Association of Genetic Factors in the Occurrence of Acne Vulgaris and its Implication in the Development of Severe Acne

Acne is an inflammatory disease that usually affects the pilosebaceous unit. It is a very common disease worldwide and its onset during puberty is common. Multiple studies have shown that up to 95% of adolescents will be affected to some degree during their lifetime, being the female sex the most affected. It is frequently associated with monogenic diseases such as Apert syndrome; comedonal nevus; Frank-ter Haar syndrome, among others. The pathogenesis is multifactorial, however, it has been demonstrated that there are four interrelated factors, being these the increase of sebum production, hyperkeratinization of the follicular infundibulum, inflammation and microbial infection. Some genes frequently involved in affected patients are SELL, DBB2 and TP53, whose function is the regulation of hemostasis and cutaneous inflammation; the regulation of apoptosis of damaged DNA and the formation of scars associated with severe acne, respectively. It is common to observe comedones, pustules, papules and cysts as characteristic lesions, face and thorax are the most frequent location. It has been shown that the incidence decreases between the fourth and fifth decades of life, also, generally in affected individuals the lesions resolve spontaneously leaving scars in severe cases.

Pellino1 Restricts Herpes Simplex Virus Infections in the Epidermis and Dissemination to Sebaceous Glands

Nearly all adults are infected with one or more herpes viruses. The most common are herpes simplex virus (HSV)-1 and HSV-2, which upon reactivation can cause painful skin and mucosal erosions. Patients who are immune compromised often experience frequent, atypical, or chronic lesions and thus a greatly diminished QOL. Pellino1 is a ubiquitin ligase involved in IL-1 and toll-like receptor signaling; however, the role of Pellino1 in skin immunity against HSV is unknown. In this study, using the mouse-flank HSV-1 skin infection model, we show that Pellino1 has several critical functions during active viral replication. Peli1‒/‒ mice succumb more than wild-type mice to systemic disease and develop larger zosteriform skin lesions along affected dermatomes. In Pellino1-deficient mice, the virus spread extensively through the epidermis and follicular infundibulum into sebaceous glands where sebocytes were found positive for the virus. The latter did not appear to involve a shift in how the virus migrated through the nervous system. Immunohistochemistry revealed delayed recruitment of myeloid and T cells to the infected epidermis in Peli1‒/‒ mice. This was associated with decreased expression of the cytokine mRNAs Il1a, Il36b and 2610528A11Rik; the latter also known as Gpr15l. In conclusion, Pellino1 plays important roles in restricting viral dissemination, and the involved pathways may represent novel therapeutic targets in patients with frequent or chronic HSV infections.

An unusual case of comedones

We present the case of a 71-year-old woman with widespread comedones since adolescence. Histological examination revealed branching hyperpigmented rete ridges and cystically dilated follicular infundibulum containing laminated keratinous debris. We explore the differential diagnosis in the context of other reticulate hyperpigmentation disorders.

Longstanding itchy axillae in a young woman

A 26-year-old woman with no history of chronic illness presented with a 5-year history of intense pruritus in both axillae, worse during hot weather, sweating, and wearing deodorant. She denied malodor, drainage, and flares with menstruation. An examination revealed hyperpigmented, monomorphous, folliculocentric papules involving both axillae (Fig 1). Histology revealed parakeratotic plugging of the follicular infundibulum; follicular spongiosis; a perifollicular, lymphohistiocytic infiltrate with scattered eosinophils; and dilated, active apocrine glands (Fig 2).

Spinulosis revealing dermatomyositis relapse: A new description of Wong’s dermatomyositis

Sir, Dermatomyositis (DM) is a systemic autoimmune disease affecting characteristically the skin and muscles. The typical cutaneous features include Gottron’s papules, a heliotrope rash, and edema of the eyelids. Spinulosis is an unusual sign, not raising suspicion for a DM diagnosis. Herein, we report a case of DM relapsing as Wong’s dermatomyositis (WDM) as an isolated spinulosic eruption. A 42-year-old female presented with a pruritic papular eruption involving both arms and the back persistent for the last two months. An anamnesis included a history of DM diagnosed five years earlier, in complete remission under the administration of corticosteroids for three years. A physical examination revealed erythematous and violaceous scaly plaques resulting from confluent follicular papules, resembling pityriasis rubra pilaris (PRP) on the lateral sides of the arms (Fig. 1) and the upper back (Fig. 2). Muscular testing was subnormal and the general status was conserved. Laboratory findings revealed a high level of blood CPK (3×N), LDH (4×N), and ASAT (3.5×N), while electromyography displayed myogenic changes. A muscular biopsy revealed necrotic muscular cells with perifascicular atrophy and lymphocytic inflammatory infiltrate. A histological skin examination found follicular hyperkeratosis with perifollicular interface dermatitis and interstitial mucin deposits in the dermis (Fig. 3). Based on these findings, the diagnosis of WDM was retained. A malignancy workup was negative. Corticosteroid therapy was initiated with prednisone 1 mg/kg/day in combination with hydroxychloroquine 200 mg twice a day, resulting in a remarkable clinical and biological improvement.WDM is characterized by the presence of PRP-like follicular papules in a patient with dermatomyositis (DM) [1]. Some authors suggest that this exceptional presentation should be considered a true association of DM with PRP rather than a variant of DM [2]. In this rare form, spinulosic lesions are mainly located on the trunk or limbs with occasional palmoplantar keratoderma [2]. Follicular lesions are usually associated with the typical signs of DM but some cases of isolated PRP features related to WDM have been reported [3]. To our knowledge, none has been reported as a relapse of a previous classic DM. Our patient relapsed showing spinulosic lesions absent in the prior episode five years earlier, not displaying at this time any classic cutaneous signs of DM. Such puzzling presentations are very unusual and may be confusing for physicians. In our patient, the diagnosis was retained on the basis of the histopathological findings of interface dermatitis and interstitial mucin deposits in the dermis, increased serum levels of muscle enzymes with a myogenic electromyographic pattern, the typical muscular histological changes, and a medical history of DM diagnosed five years earlier. In WDM, histology usually reveals follicular hyperkeratosis with keratotic plugs filling dilated follicular infundibula, which may raise several differential diagnoses, including PRP, discoid lupus erythematosus (DLE), and, to a lesser degree, follicular psoriasis and keratosis pilaris [4]. Interface dermatitis and mucin deposits, as in our patient, are the hallmarks of distinguishing DM from PRP, follicular psoriasis, and keratosis pilaris. Although these findings may also be observed in DLE [4], in our patient, there were no clinical or histological arguments supporting DLE rather than a diagnosis of DM. Myositis as, well as interstitial lung disease, appears to be comparable to the classic variant [5]. The risk of associated internal malignancy is unknown but could be lower than in the classic form [4]. Treatment and management do not differ from classic dermatomyositis.

A Case of Tumor of Follicular Infundibulum in Parietal Scalp

Tumor of follicular infundibulum (TFI) is a rare benign cutaneous appendage tumor that does not have characteristic clinical features. It is mainly present in the head, neck, and trunk as a solitary lesion. In particular, TFI typically manifests as a plate-like proliferation with multiple thin epidermal connections comprise of monomorphic cells. TFI do not represent cutaneous characteristics, but have clinical significance because TFI is associated with basal cell carcinoma and Cowden's syndrome. We report a case of TFI in parietal scalp with a review of literatures.

Sebaceous gland extrusion

The extrusion of a sebaceous gland through a follicular infundibulum is a rare dermatopathology image that raises two fundamental questions: Is it an artifact?. Can a full gland be expelled just as its secretion does?. The answer is not easy and there are no bibliographic references to help us solving the doubt. These two images correspond to the case of an 18-year-old male patient who consulted for a rapidly evolving yellowish nummular lesion on the cheek. An oily secretion was released from it.

Nevus Comedonicus, a Rare Case : Dermoscopic and Histopathological Findings

Nevus comedonicus is an extremely rare adnexal hamartoma of pilosebaceous apparatus, with approximately 200 cases reported in the literature so far. It appears as cluster of adjacent honeycomb-like dillated follicular openings with firm pigmented keratin plugs resembling comedones.The comedones oftentimes arranged in linear pattern paralled to Blaschko’s lines. We report a case of a 5-year-old boy with open brown to black comedones in a linear pattern localized on the back of the left thigh that appearing since birth. Pain, itch and discharge were not obtain. There were some episodes of infection, due to manual removal done by his mother which left some hypertrophic scars. Dermoscopic examination revealed the distinctive pattern consisting of pigmented, sharply demarcated keratin plugs of 1-3 mm in diameter, some open pores, multiple structurless, various shades of brown homogenous circular areas surrounding the plugs. Histopathological examination showed an aggregation of dilated follicular infundibulum with laminated keratinous material plugging. This case report prove that dermoscopy examination, a simple non-invasive diagnostic tool is very helpful in diagnosing nevus comedonicus. We recommend this tool to differentiate the diagnosis of other rare epidermal nevi while histopathological examination should be performed only in uncertain cases.

Skin tumors in xeroderma pigmentosum: Evaluation of a large series and a literature review

Xeroderma pigmentosum (XP) is a rare genodermatosis with a lifelong propensity to develop malignant skin tumors. In this retrospective study, 24 XP patients were evaluated with regard to frequency and clinicopathological features of benign and malignant skin tumors. Seventeen patients had at least one malignant skin tumor diagnosed: basal cell carcinoma (BCC) in 13 patients (n=72), basosquamous carcinoma in three patients (n=4), squamous cell carcinoma in six patients (n=13), keratoacanthoma in three patients (n=15), and melanoma in six patients (n=18). Most melanomas (n=15) were in situ lesions. Several benign skin tumors were noted such as tricholemmoma (n=1), trichoepithelioma (n=1), trichoblastoma (n=1), follicular infundibulum tumor (n=1), keratoacanthoma-like follicular lesion (n=1), adnexal tumors with folliculosebaceous (n=1) and tricholemmal differentiation (n=1), and neurofibroma (n=1). Benign vascular proliferations including pyogenic granulomas (n=8), widespread telangiectasias, and senile angioma-like lesions were also observed in 3, 5, and 5 patients, respectively. Similar to many reports, BCC was found to be the most common malignant skin tumor. The high prevalence of benign adnexal tumors of follicular differentiation, some of them showing mixed histopathological features and various vascular proliferations in our series raises the question of whether they indicate a formerly undescribed association with XP.

A Study of Clinical, Dermoscopic and Histopathological Correlation in Follicular Keratotic Diseases: Preliminary Observations in 30 Cases.

Context:Follicular keratotic disorder is an abnormal keratinization affecting the follicular orifices and clinically characterized by hyperkeratotic follicular papules affecting various sites. Dermoscopy is a non-invasive diagnostic tool and differentiates closely resembling diseases as well as possibly prevents need for an invasive biopsy.Aim:This study was aimed to find the correlation between clinical, dermoscopic and histopathological findings in follicular keratotic diseases and to establish the dermoscopic criteria in the diagnosis of primary follicular keratotic diseases.Materials and Methods:This was a hospital-based prospective cross-sectional study of 30 consecutive patients clinically diagnosed with follicular keratotic diseases, irrespective of age and duration of the disease.Results:The study consisted of 30 patients with a mean age of 19.57 ± 9.69 years. The most common primary follicular keratotic disease observed was phrynoderma and secondary follicular keratotic disease was follicular lichen planus (lichen planopilaris). The predominant dermoscopic finding among all the follicular keratotic diseases was perifollicular scaling 29 (96.7%) followed by keratotic plug 28 (93.3%). The most common histopathological feature was dilated follicular infundibulum 22 (73.3%) followed by follicular plug 15 (50%) and dermal perivascular infiltration 22 (73.3%). The clinical and dermoscopic features showed a significant statistical association with the histopathological findings.Conclusion:Dermoscopy is a simple, non-invasive diagnostic tool that helps in differentiating and diagnosing the closely resembling follicular keratotic diseases.

Keratoacanthoma, committed stem cells and neoplastic aberrant infundibulogenesis integral to formulating a conceptual model for an infundibulocystic pathway to squamous cell carcinoma.

Keratoacanthomas (KAs) are distinctive tumors that are defined by their clinical and histopathological features. Their relationship and distinction from squamous cell carcinoma (SCC), however, remain controversial. All cytogenic and immunohistochemical markers that have been applied in this quest have failed. A close relationship of KAs to hair follicles has been recognized. The descriptive term infundibulocystic or infundibular SCC was introduced to define a more broad‐based pathway encompassing KAs. The follicular infundibulum roles in respect to neoplasia and wound healing are important elements in understanding the pathogenesis of KAs. Mouse models for KA have provided insights into the relationship of KA to follicles and SCCs. These advances and together with the diverse clinical and histopathological aspects of KA have contributed to the formulation of a conceptual pathway. The central element is that ultraviolet (UV)‐mutated or activated committed infundibular stem cells are driven by the combination of a mutated oncogenic RAS pathway linked with the Wnt/beta‐catenin pathway responsible for stem cell maintenance, hair follicle development, wound healing and driving KA proliferation and terminal keratinization. The existence and activation of this mutated pathway may form the basis of the paradoxical emergence of KAs and SCCs in patients receiving BRAF and PD‐1 inhibitor therapy.

Investigation of monocyte HDL ratio as an indicator of inflammation and complete blood count parameters in patients with acne vulgaris.

Acne vulgaris is a common inflammatory skin disease that affects the pilosebaceous unit. Increased sebum production, hyperkeratosis in follicular infundibulum, inflammation and Propionibacterium acnes are among aetiological factors. Complete blood count (CBC) parameters are used as diagnosis biomarkers for many diseases related with inflammatory processes. Although monocyte/HDL ratio (MHR) has been defined as an inflammatory marker recently, we did not come across any studies about MHR in acne, which is known to be an inflammatory disease. The present study was conducted to compare CBC parameters and MHR levels in acne vulgaris patients and healthy controls (HCs). Sixty-five acne vulgaris patients followed in our clinic between January 2018 and December 2019 and 36 HCs matching in terms of age and sex were included in the study. Patients and HCs were compared in terms of CBC parameters [neutrophil, monocyte, platelet, lymphocyte, neutrophil/lymphocyte (NLR), monocyte/lymphocyte (MLR), platelet/lymphocyte (PLR)], HDL and MHR ratio. When compared with the HCs, acne vulgaris patients had statistically significantly higher neutrophil, NLR ratio and HDL (P=.042, P=.011 and P=.014, respectively). No statistically significant difference was found between acne vulgaris patients and the HCs in terms of other CBC parameters and MHR ratio (P>.05). We believe that prospective studies consisting of large patient series are needed to understand whether CBC parameters and MHR ratio can be used as an inflammatory marker in acne vulgaris patients.

757 Clinical efficacy of topical autophagy activator on acne-prone skin

Hyperkeratosis in follicular infundibulum, increased sebum formation, and inflammation are major factors in acne pathogenesis. Recent studies about the important roles of autophagy signaling in sebogenesis and epidermal differentiation suggest potential benefits of autophagy activator on acne. In this study, in vitro and clinical studies were performed to investigate the effects of autophagy activator on acne-prone skin. Autophagy signaling in sebocytes SZ95 and keratinocytes was observed and effects of autophagy activating peptide on sebum generation in sebocytes was also investigated.