Pathophysiology Of Acne Research Articles

The Role of Toll-Like Receptors in the Pathophysiology of Acne

Acne vulgaris is a common cutaneous disorder of the pilosebaceous follicle, affecting more than 45 million people in the United States alone. The pathogenesis of acne is multifactorial, involving abnormal hyperkeratinization, increased sebum production, hormones, cutaneous microbes, and immunological mechanisms. Many of the immunological processes that contribute to the formation of acne lesions take place at the very site of disease, the skin. Skin is an important component of the innate immune system, providing both physical barriers and rapid cellular responses by keratinocytes, Langerhans cells, and other infiltrating inflammatory cells. In this review, we discuss the ability of the innate immune system to use Toll-like receptors (TLRs) to recognize microbial patterns and initiate immune responses in cutaneous disorders. Because TLRs are vital players in infectious and inflammatory diseases, they are potential therapeutic targets. Indeed, the ability of TLRs to combat disease already has been harnessed through the development of drugs that act as TLR agonists. A better understanding of TLRs will allow for the development of new therapeutic options for cutaneous inflammatory diseases such as acne.

Is acne really a disease?: a theory of acne as an evolutionarily significant, high-order psychoneuroimmune interaction timed to cortical development with a crucial role in mate choice

Adolescent acne is considered from the perspective of evolutionary psychology with an emphasis on a role in mate choice. The fact that acne, which is almost universal and not a true infection, is (1) initiated at puberty by the action of pubertal hormones on likely distinct, pro-acne follices, and (2) typically resolves in one’s early twenties when prefrontal cortex development is complete, suggests that the condition’s timeframe is meaningful. Acne’s conspicuous localization on the face, and its ability to elicit reflexive disgust and avoidance in observers, suggests a possible role in sexual selection. The pathophysiology of acne is reviewed, and the suggestion made that, far from being a disease, adolescent acne is a normal physiological process – a high-order psychoneuroimmune interaction – that functions to ward off potential mates until the afflicted individual is some years past the age of reproductive maturity, and thus emotionally, intellectually, and physically fit to be a parent.

Optimal management of acne to prevent scarring and psychological sequelae.

Acne vulgaris is one of the most common inflammatory dermatoses and is seen in both the hospital setting and in general practice. Multiple factors are involved in the pathophysiology of acne, including: an alteration in the pattern of keratinization within the pilosebaceous follicles resulting in comedone formation; an increase in sebum production which is influenced by androgens; the proliferation of Propionibacterium acnes; and the production of perifollicular inflammation. Genetic and hormonal factors may also contribute to acne. Better understanding of the pathophysiology of the disease has led to the development of novel therapies which are directed at one or more of the implicated etiologic factors. Systemic antibiotics for acne have been the mainstay of treatment for many years. The main cause for concern following the use of systemic antibiotics is the emergence of antibiotic-resistant strains of P. acnes. Concomitant use of non-antibiotic therapies such as benzoyl peroxide helps to decrease the occurrence of resistance and can be effective in the treatment of resistant and nonresistant propionibacterial strains. However, no one agent is able to eradicate resistant strains completely and as resistant strains correlate to poor clinical response to therapy, prescribing strategies are required to minimize the occurrence of resistance to P. acnes. When assessing acne it is important to take an all embracing approach and to examine carefully for both the clinical and psychologic effects of the disease process. There are numerous forms of acne scarring and it is important to be aware of these as patients who are developing scarring merit early effective therapy. Some patients with acne will develop psychologic problems as a consequence of their condition. Even mild to moderate disease can be associated with significant depression and suicidal ideation and psychologic change does not necessarily correlate with disease severity. Acne scars themselves have been shown to produce significant psychopathology. When initiating treatment it is important to consider the aims of therapy. Treatment should be aimed at achieving clearance of acne, prevention of scarring and, where necessary, relief from any psychologic stress resulting from the acne. Therapy should be commenced early in the disease process in order to prevent scarring and it is important to select appropriate therapies according to the clinical signs and psychologic disability. It is also important to ensure that the patient is able to comply with therapy and clear guidelines regarding treatment, possible adverse effects and realistic expectations should be provided.

New treatments and therapeutic strategies for acne.

Successful management of acne requires careful patient evaluation followed by consideration of several patient and medication factors when selecting a particular therapeutic regimen. Within the last few years, several new agents for the treatment of acne have become available that afford greater flexibility in the treatment of this prevalent dermatologic disorder. These include adapalene, tazarotene, 2 new topical tretinoin formulations, azelaic acid, a new sodium sulfacetamide formulation, and an oral contraceptive recently approved by the Food and Drug Administration for the treatment of acne. After a brief overview of the pathophysiology of acne and existing therapies, this review evaluates the new antiacne agents and how they can be integrated into a successful treatment strategy that takes into account acne severity and predominant lesion type as well as age, skin type, lifestyle, motivation, and the presence of coexisting conditions.

Determination of glycogen and enzymes of glycogen metabolism in human hair follicles.

The skin epithelium and its organelles use glycogen as well as glucose as source of energy. Therefore the characterisation of glycogen metabolism and the enzymes involved is important in the study of mechanisms regulating the normal or abnormal differentiation of skin organelles such as sebaceous glands and hair follicles. The present paper describes fluorimetric methods for the determination of glycogen and for the measurements of phosphorylase and phosphorylase kinase activity in one and the same lysate of minute tissue samples. The methods were tested for their suitability on freshly isolated human hair follicles and cultured hair follicle cells. The possible use of these techniques for studies on the pathophysiology of acne and hirsutism is discussed.