IN THIS ISSUE of the ARCHIVES, Thiboutot et al1 report new findings on the hormonal aspects of acne, a multifactorial disease whose understanding has progressed in bursts over the past few decades. The 1960s and 1970s were the decades when the central role of Propionibacterium acnes was discovered. In those decades, the interaction of P acnes with neutrophils and complement was elucidated, and the roles of immunity and hypersensitivity in determining acne severity were appreciated.2,3 Current thinking holds that the microcomedo is the initial lesion of acne. Microcomedones form, at least in part, before puberty as a result of unknown stimuli. The pubertal surge in androgens triggers sebaceous gland growth and activity, and comedonal P acnes proliferates through feeding on the abundant sebaceous triglycerides.
Webster GF. Acne Vulgaris: State of the Science. Arch Dermatol. 1999;135(9):1101–1102. doi:10.1001/archderm.135.9.1101
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