Four major factors are involved in the pathogenesis of acne: (1) increased sebum production with altered lipid composition, (2) metagenomic modifications of the P. acnes microbiome favoring P. acnes biofilm, (3) deviated acroinfundibular keratinization leading to comedogenesis, and (4) inflammasome activation with infiltration of inflammatory cells into the perifollicular dermis. All four factors are interdependent. In our opinion quantitative and qualitative alterations of sebum represent the initial event driving all other related pathological features of acne.
- Agamia NF, Abdallah DM, S Sorour O, et al. Skin expression of mammalian target of rapamycin (mTOR), forkhead box transcription factorO1 (FoxO1) and serum insulin-like growth factor-1 (IGF-1) in patients with acne vulgaris and their relationship with diet. Br J Dermatol. 2016;174:1299–307.CrossRefGoogle Scholar
- Scholz CF, Kilian M. The natural history of cutaneous propionibacteria, and reclassification of selected species within the genus Propionibacterium to the proposed novel genera Acidipropionibacterium gen. nov., Cutibacterium gen. nov. and Pseudopropionibacterium gen. nov. Int J Syst Evol Microbiol. 2016;66:4422–32.CrossRefGoogle Scholar