Mechanism of Acne
1) Abnormal proliferation of skin cells – Follicular hyperkeratinization with subsequent plugging of the follicle. Treated with Vitamin A derivatives (topical retinoids and oral isotretinoin for nodulocystic /conglobate acne).
2) Inflammation (“cellulitis”) caused by Cutibacterium acnes ( formerly Propionibacterium acnes) – treated with topical antimicrobial, topical antibiotics, and oral antibiotics.
3) Release of inflammatory mediators into the skin.
3) Excess sebum production: Overproduction of Sebum related to androgenic hormones and genetics. OCPs are used for acne and a spironolactone (an antiandrogen?)
Treatment targets the four factors responsible for acne formation: 1) increased sebum production, 2) hyperkeratinization, 3) colonization by Cutibacterium acnes, and 4) the resultant inflammatory reaction.