THE PRIMARY lesion of acne vulgaris is generally conceded to be the comedo. In all probability there are multiple factors which play a part in the formation of this anatomical defect and its close relative, the milium. It has long been speculated by Sulzberger, and reported by him and his associates, Witten1 and Berger2 that it is possible that in modern man the lanugo hair may represent a vestigial and disappearing organ no longer capable of doing the job of its coarse and thicker predecessor in holding open the follicular orifices. The failure of certain of the feeble lanugo hairs to keep patent the opening of the follicle and to maintain adequate drainage of sebum would seem to be sufficient to account for the comedones which appear in susceptible persons at puberty
RINGROSE EJ, EKBLAD GH. ALOPECIA AREATA, ACNE, AND MILIA: Report of a Unique Case Illustrating the Importance of Hair as a Natural Drain. AMA Arch Derm Syphilol. 1952;66(6):722–727. doi:10.1001/archderm.1952.01530310060009
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