Easy-to-miss points and treatment strategies in the intractable acne

초록

Acne vulgaris is a chronic inflammatory disease ? rather than a natural part of the life cycle ? of the pilosebaceous unit (comprising the hair follicle, hair shaft and sebaceous gland) and is among the most common dermatological conditions worldwide. The key mechanisms involved in the development of acne include disturbed sebaceous gland activity associated with hyperseborrhoea (that is, increased sebum production) and alterations in sebum fatty acid composition, dysregulation of the hormone microenvironment, interaction with neuropeptides, follicular hyperkeratinization, induction of inflammation and dysfunction of the innate and adaptive immunity. - Sebum is secreted by the sebaceous gland and comprises an oily mixture of triglycerides, wax esters, squalene, free fatty acids and small amounts of cholesterol, cholesterol esters and diglycerides. - Acne is also associated with alterations in the free fatty acid composition of sebum. Sebum of patients with acne contains less essential (that is, fatty acids that cannot be synthesized by the body and can only be acquired from the diet) free fatty acids (including linoleic acid) - Pro-inflammatory sebum lipid fractions (monounsaturated fatty acids (MUFAs) and lipoperoxides; see below) have been associated with the development of acne lesions, and the skin surface lipid oxidant to antioxidant ratio is another acne stimulus - the levels of dehydroepiandrosterone (DHEA) were most frequently elevated44. In a recent cross-sectional study, androstenedione and testosterone levels were higher (P < 0.0001) in patients with acne than in healthy controls. - Adult women and men with acne have increased serum levels of insulin-like growth factor 1 (IGF1). In women, serum IGF1 levels are correlated with the number of acne lesions, facial sebum excretion rate in postadolescent patients and serum levels of 5α-DHT and DHEA sulfate - Modern lifestyle, diet and smoking