Controversies in Experimental Dermatology
Section Editor: Ralf Paus
What is the pathogenesis of acne?
C. C. Zouboulis, A. Eady, M. Philpott,
L. A. Goldsmith, C. Orfanos, W. C.
Cunliffe and R. Rosenfield
Zouboulis CC, Eady A, Philpott M, Goldsmith LA, Orfanos C, Cunliffe WC
Rosenfield R. What is the pathogenesis of acne?
Exp Dermatol 2005: 14: 143–152. # Blackwell Munksgaard, 2005
Abstract: For a long time, the mantra of acne pathogenesis debates has been that
acne vulgaris lesions develop when (supposedly largely androgen-mediated)
increased sebum production, ductal hypercornification, and propionibacteria come
together with local inflammatory process in the unlucky affected individual. And
yet, the exact sequence, precise interdependence, and choreography of pathogenic
events in acne, especially the ‘match that lights the fire’ have remained surprisingly
unclear, despite the venerable tradition of acne research over the past century.
However, exciting recent progress in this – conceptually long somewhat stagnant, yet
clinically, psychologically, and socioeconomically highly relevant – everyday battlefield
of skin pathology encourages one to critically revisit conventional concepts of acne
pathogenesis. Also, this provides a good opportunity for defining more sharply key
open questions and intriguing acne characteritics whose underlying biological basis has
far too long remained uninvestigated, and to emphasize promising new acne research
avenues off-the-beaten-track – in the hope of promoting the corresponding
development of innovative strategies for acne management.
Prelude
Dear Sir,
I have to confess that I much hated Peter, John, William
and Albert, respectively, from Boston, Iowa-City, Leeds and
Philadelphia. The latter described me as ‘a bewitching lady,
pursued with more passion than intelligence’ (1).
Since centuries, I have dedicated my long life to revenge.
Afflicted by various skin disgraces, my face is, by itself, a text-
book of Dermatology. Disadvantaged, I hate adolescence, its
blossoming promises