Acne and Rosacea

Acne and Rosacea

Understand the pathophysiology of acne vulgaris with regard to the interplay of different factors,  Foot Pad

including the local milieu of the pilosebaceous unit, hormones, bacteria, and systemic factors.

Understand  the individual steps required for comedogenesis at the level of the pilosebaceous unit.

Recognize the clinical types of acne and its common variants, as well as correlate the basic histologic

features of each.

Understand the basic proposed pathophysiology of rosacea with regard to the possible roles of the

vasculature, nervous system, environment, and skin flora.

Recognize the clinical subtypes of rosacea as well as appreciate the basic histopathologic features of


The pilosebaceous unit and sebum

Acne is centered on the pilosabecous unit.

At age 7 sebum production increases called adrenarche, and peaks in the 20’s

Sebaceous glands are made of sebocytes which accumulate lipid as they grow.  Sebocytes

are secreted by holocrine secretion into the lumen of the gland then into the


Sebum composition is unique made of squalene, cholesterol, wax esters.

Regulation of sebaceous glands

Androgens are required for sebum production esp T and DHT, but don’t explain it all b/c

sebum production does not parallel androgen levels. And is not proportionately

more in men that women.

DHEAS is a weak androgen and via 5areductase is the driving force for sebum แผ่นแปะเท้า



Normal keratin is loosely organized in granules in the follicle.

Increased keratin density and decreased keratinocyte apoptosis.

Lower levels of fatty acids to dilute the keratin

IL-1 may play a role as well as there is more of this in an acne prone follicle.

Proprionibacterium acnes is a G+, non-motile, anaerobic bacterium, and may play an

important role in acne.  May break down ffa’s leading to inflammation.  May also

produce chemotactic factors to attract PMN’s and T cells.

Clinical manifestations of acne

Closed comedone- Inflammatory infiltrate by the lymphocyte.  This grows to become the

“whitehead” baby

Open comedone- or blackhead is similar in formation to closed comedone, black color is

due to melanocytes.

As the inflammation proceeds the papulopustule forms that is red and tender, and filled

with PMN rich pus blocking the follicle. daddy

Acne fulminans is severe acne known as acute febrile ulcerative acne, and is systemic,

this can be a hospitalizeable emergency.

Neonatal acne can be caused by malassezia furfur yeast

Infantile acne caused by premature DHEAS production

Occupational acne

People working with oils and tars as well as chlorinated hydrocarbons (chloracne

Yuschenko with dioxin poison)

Drug Induced acne can be caused by steroids

Endocrine acne  classical case is a woman with cystic acne, hirsutism, irregular

menstruation, fertility problems, and obesity.  These all point to the hyperadrenogenic state usually caused by polycystic ovary syndrome (PCOS).

Insulin has been related to PCOS the insulin growth factor can stimulate the ovary

increasing androgen production and at the same time inhibit of a sex hormone binding globulin amplifying the problem.

Glycemic foods may contribute by increasing insulin levels.


Highest risk in fair skin northern Europeans


Defect may lie in the vascular system (patients are more likely to get migraines, and

blood flow is higher in patients, also see telangiectasia)

the organism demodex, a follicle mite, has been implicated

Clinical manifestation

Stage 1: pre-rosacea, vascular flushing

Stage 2: vascular rosacea, lasting redness

Stage 3: persistent inflammed rosacea, inflamed papules and pustules, but no comedones.

Stage 4: end stage rosacea, fibrosis, sebaceous overgrowth, can get rhynophyma.

Must also keep an eye on ocular rosacea as it may cause irritation and blindness.

Steroid rosacea too can make the face “angry” looking.


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Posted on กันยายน 10, 2012, in บทความ. Bookmark the permalink. ใส่ความเห็น.


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