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New developments in our understanding of acne pathogenesis and treatment |
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| Authors: | Ichiro Kurokawa F William Danby Qiang Ju Xiuli Wang Leihong Flora Xiang Longqing Xia WenChieh Chen István Nagy Mauro Picardo Dae Hun Suh Ruta Ganceviciene Silke Schagen Fragkiski Tsatsou Christos C Zouboulis |
| Institution: | Department of Dermatology, Mie Universtity Graduate School of Medicine, Tsu, Mie, Japan;; Division of Dermatology, Dartmouth Medical School, Hanover, NH, USA;; Department of Dermatology, Hospital of Dermatology and Venereology of Shanghai, Shanghai, China;; Department of Dermatology, Hua Shan Hospital, Shanghai Medical College, Fu Dan University, Shanghai, China;; Institute of Dermatology, Chinese Academy of Medical Sciences &Peking Union Medical College, Nagqing, China;; Department of Dermatology and Allergy, Technische Universitaet Muenchen, Munich, Germany;; Department of Dermatology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan;; Institute for Plant Genomics, Human Biotechnology and Bioenergy, Bay Zoltán Foundation for Applied Research, Szeged, Hungary;; San Gallicano Dermatological Institute, Rome, Italy;; Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea;; Centre of Dermatovenereology, Vilnius University Hospital, Vilnius, Lithuania;; Pentapharm, Aesch, Switzerland;; University of Basel, Basel, Switzerland;; s&kGrey, Freiburg, Germany;; Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany;; Laboratory for Biogerontology, Dermato-Pharmacology and Dermato-Endocrinology, Institute of Clinical Pharmacology and Toxicology, CharitéUniversitaetsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany |
| Abstract: | Abstract: Interest in sebaceous gland physiology and its diseases is rapidly increasing. We provide a summarized update of the current knowledge of the pathobiology of acne vulgaris and new treatment concepts that have emerged in the last 3 years (2005–2008). We have tried to answer questions arising from the exploration of sebaceous gland biology, hormonal factors, hyperkeratinization, role of bacteria, sebum, nutrition, cytokines and toll-like receptors (TLRs). Sebaceous glands play an important role as active participants in the innate immunity of the skin. They produce neuropeptides, excrete antimicrobial peptides and exhibit characteristics of stem cells. Androgens affect sebocytes and infundibular keratinocytes in a complex manner influencing cellular differentiation, proliferation, lipogenesis and comedogenesis. Retention hyperkeratosis in closed comedones and inflammatory papules is attributable to a disorder of terminal keratinocyte differentiation. Propionibacterium acnes, by acting on TLR-2, may stimulate the secretion of cytokines, such as interleukin (IL)-6 and IL-8 by follicular keratinocytes and IL-8 and -12 in macrophages, giving rise to inflammation. Certain P. acnes species may induce an immunological reaction by stimulating the production of sebocyte and keratinocyte antimicrobial peptides, which play an important role in the innate immunity of the follicle. Qualitative changes of sebum lipids induce alteration of keratinocyte differentiation and induce IL-1 secretion, contributing to the development of follicular hyperkeratosis. High glycemic load food and milk may induce increased tissue levels of 5α-dihydrotestosterone. These new aspects of acne pathogenesis lead to the considerations of possible customized therapeutic regimens. Current research is expected to lead to innovative treatments in the near future. |
| Keywords: | sebaceous gland acne cytokine Toll-like receptor PPAR hyperkeratinization |