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Current Concepts of the Pathogenesis of Acne

Implications for Drug Treatment

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Abstract

The pathogenesis of acne is complex, with strong evidence supporting the involvement of sebaceous hyperplasia, follicular hyperkeratinisation, bacterial hypercolonisation, as well as immune reactions and inflammation. High sebum concentrations and follicular hyperkeratinisation lead to a change of the follicular milieu with consecutive proliferation of bacteria, chiefly Propionibacterium acnes. This leads to further increased production of the pro-inflammatory cytokines interleukin-1α and tumour necrosis factor α by T cells and keratinocytes, leading to proliferation of both cell types. Follicular keratinocytes fail to differentiate by apoptosis and produce hypergranulosis similar to the impermeable skin outer layer, resulting in the formation of microcomedones. Further inflammatory responses lead to the development of increasing degrees of severity in inflammatory forms of acne.

Retinoids aid the differentiation and reduce the hyperproliferation of keratinocytes, and can inhibit the migration of leucocytes. Combination therapy using retinoids plus benzoyl peroxide or antibacterials can treat existing acne lesions faster than the individual agents alone and can also prevent the development of new lesions. The new retinoids (e.g. adapalene) have not only the typical potent comedolytic activity but also anti-inflammatory effects. When added to antibacterial therapy, topical retinoids demonstrate faster and significantly greater reduction of inflammatory acne lesions and comedones than antibacterials alone.

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References

  1. White GM. Recent findings in the epidemiology, classification and subtypes of acne vulgaris. J Am Acad Dermatol 1998 Aug; 39 (2 Pt 3): 534–7

    Article  Google Scholar 

  2. Kelly AP. Acne and related disorders. In: Sams WMJ, Lynch PJ, editors. Principles and practice of dermatology. New York: Churchill Livingstone, 1996: 801–18

    Google Scholar 

  3. Clark SM, Goulden V, Finlay AY, et al. The psychological and social impact of acne: a comparison study using three acne disability questionnaires [abstract]. Br J Dermatol 1997; 137 Suppl. 50: 41

    Google Scholar 

  4. Gupta MA, Johnson AM, Gupta AK. The development of an acne quality of life scale: reliability, validity, and relation to subjective acne severity in mild to moderate acne vulgaris. Acta Derm Venereol (Stockh) 1998; 78: 451–6

    Article  CAS  Google Scholar 

  5. Cotterrill JA, Cunliffe WJ. Suicide in dermatological patients. Br J Dermatol 1997 Aug; 137(2): 246–50

    Article  Google Scholar 

  6. Gupta MA, Gupta AK. Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. Br J Dermatol 1998 Nov; 139(5): 846–50

    Article  PubMed  CAS  Google Scholar 

  7. Lasek RJ, Chren M. Acne vulgaris and the quality of life of adult dermatology patients. Arch Dermatol 1998 Apr; 134(4): 454–8

    Article  PubMed  CAS  Google Scholar 

  8. Cunliffe WJ. Acne and unemployment [letter]. Br J Dermatol 1986 Sep; 115(3): 386

    Article  PubMed  CAS  Google Scholar 

  9. Shalita AR. Clinical aspects of acne. Dermatology 1998; 196(1): 93–4

    Article  PubMed  CAS  Google Scholar 

  10. Cunliffe WJ, Gollnick H. Acne diagnosis and management. London: Martin Dunitz, 2001

    Google Scholar 

  11. Deplewski D, Rosenfield RL. Role of hormones in pilosebaceous unit development. Endocr Rev 2000 Aug; 21(4): 363–92

    Article  PubMed  CAS  Google Scholar 

  12. Zouboulis CC. Human skin: an independent peripheral endocrine organ. Horm Res 2000; 54(5–6): 230–42

    Article  PubMed  CAS  Google Scholar 

  13. Plewig G, Kligman AM. Acne and rosacea. 3rd ed. New York: Springer-Verlag, 2000

    Book  Google Scholar 

  14. Gollnick HP, Zouboulis CC, Akamatsu H, et al. Pathogenesis and pathogenesis related treatment of acne. J Dermatol 1991 Sep; 18(9): 489–99

    PubMed  CAS  Google Scholar 

  15. Thiboutot D, Knaggs H, Gilliland K, et al. Activity of 5-alpha-reductase and 17-beta-hydroxysterid dehydrogenase in the infrainfundibulum of subjects with and without acne vulgaris. Dermatology 1998; 196(1): 38–42

    Article  PubMed  CAS  Google Scholar 

  16. Zouboulis CC, Xia L, Akamatsu H, et al. The human sebocyte culture model provides new insights into development and management of seborrhoea and acne. Dermatology 1998; 196(1): 21–31

    Article  PubMed  CAS  Google Scholar 

  17. Turksen K, Troy TC. Epidermal cell lineage. Biochem Cell Biol 1998; 76(6): 889–98

    Article  PubMed  CAS  Google Scholar 

  18. Pierard GE, Goffin V, Hermanns-Le T, et al. Corneocyte desquamation. Int J Mol Med 2000 Aug; 6(2): 217–21

    Article  PubMed  CAS  Google Scholar 

  19. Cunliffe WJ, Holland DB, Clark SM, et al. Comedogenesis: some new aetiological, clinical and therapeutic strategies. Br J Dermatol 2000 Jun; 142(6): 1084–91

    Article  PubMed  CAS  Google Scholar 

  20. Kurokawa I, Mayer-da-Silva A, Gollnick H, et al. Monoclonal antibody labelling for cytokeratins and filaggrin in the human pilosebaceous unit of normal, seborrhoeic and acne skin. J Invest Dermatol 1988 Dec; 91(6): 566–71

    Article  PubMed  CAS  Google Scholar 

  21. Hurwitz S. Acne vulgaris: its pathogenesis and management. Adolesc Med 1990 Jun; 1(2): 301–14

    PubMed  Google Scholar 

  22. Paus R. Principles of hair cycle control. J Dermatol 1998 Dec; 25(12): 793–802

    PubMed  CAS  Google Scholar 

  23. Knaggs HE, Holland DB, Morris C, et al. Quantification of cellular proliferation in acne using the monoclonal antibody Ki-67. J Invest Dermatol 1994 Jan; 102(1): 89–92

    Article  PubMed  CAS  Google Scholar 

  24. Aldana OL, Holland DB, Cunliffe WJ. Variation in pilosebaceous duct keratinocyte differentiation in acne patients. Dermatology 1998; 196(1): 98–9

    Article  PubMed  CAS  Google Scholar 

  25. Hughes BR, Morris C, Cunliffe WJ, et al. Keratin expression in pilosebaceous epithelia in truncal skin of acne patients. Br J Dermatol 1996 Feb; 134(2): 247–56

    Article  PubMed  CAS  Google Scholar 

  26. Knaggs HE, Hughes BR, Morris C, et al. Immunohistochemical study of desmosomes in acne vulgaris. Br J Dermatol 1994 Jun; 130(6): 731–7

    Article  PubMed  CAS  Google Scholar 

  27. Knaggs HE, Layton AM, Morris C, et al. Investigation of the expression of the extracellular matrix glycoproteins tenascin and fibronectin during acne vulgaris. Br J Dermatol 1994 May; 130(5): 576–82

    Article  PubMed  CAS  Google Scholar 

  28. Thiboutot DM, Knaggs H, Gilliland K, et al. Activity of type I 5α-reductase is greater in the follicular infundibulum compared with the epidermis. Br J Dermatol 1997 Feb; 136(2): 166–71

    Article  PubMed  CAS  Google Scholar 

  29. Lucky AW, Henderson TA, Olson WH, et al. Effectiveness of norgestimate and ethinyl estradiol in treating moderate acne vulgaris. J Am Acad Dermatol 1997 Nov; 37(5 Pt 1): 746–54

    Article  PubMed  CAS  Google Scholar 

  30. Gollnick H, Albring M, Brill K. The efficacy of oral cyproterone acetate in combination with ethinyloestradiol in acne tarda of the facial type. J Dermatol Treat 1998 Jun; 9(2): 71–9

    Article  CAS  Google Scholar 

  31. Piérard GE, Piérard-Franchimont C, Le T. Seborrhoea in acneprone and acne-free patients. Dermatologica 1987; 175(1): 5–9

    PubMed  Google Scholar 

  32. Schmidt JB, Spona J, Huber J. Androgen receptor in hirsutism and acne. Gynecol Obstet Invest 1986; 22(4): 206–11

    Article  PubMed  CAS  Google Scholar 

  33. Henze C, Hinney B, Wuttke W. Incidence of increased androgen levels in patients suffering from acne. Dermatology 1998; 196(1): 53–4

    Article  PubMed  CAS  Google Scholar 

  34. Davis S. Syndromes of hyperandrogenism in women. Aus Fam Physician 1999 May; 28(5): 447–51

    CAS  Google Scholar 

  35. Thiboutot D, Harris G, Iles V, et al. Activity of the type I 5α-reductase exhibits regional differences in isolated sebaceous glands and whole skin. J Invest Dermatol 1995 Aug; 105(2): 209–14

    Article  PubMed  CAS  Google Scholar 

  36. Chen W, Zouboulis CC, Fritsch M, et al. Heterogeneity and quantitative differences of type I 5α-reductase expression in cultured skin epithelial cells. Dermatology 1998; 196(1): 51–2

    Article  PubMed  CAS  Google Scholar 

  37. Törmä H. Interaction of isotretinoin with endogenous retinoids. J Am Acad Dermatol 2001 Nov; 45 Suppl. 5: S143–9

    Article  PubMed  Google Scholar 

  38. Cunliffe WJ. The sebaceous gland and acne: 40 years on. Dermatology 1998; 196(1): 9–15

    Article  PubMed  CAS  Google Scholar 

  39. Akamatsu H, Zouboulis CC, Orfanos CE. Control of human sebocyte proliferation in vitro by testosterone and 5-alpha-dihydrotestoterone is dependent on the localization of the sebaceous glands. J Invest Dermatol 1992 Oct; 99(4): 509–11

    Article  PubMed  CAS  Google Scholar 

  40. Rosenfield RL, Deplewski D, Kentsis A, et al. Mechanisms of androgen induction of sebocyte differentiation. Dermatology 1998; 196(1): 43–6

    Article  PubMed  CAS  Google Scholar 

  41. Rosenfield RL, Kentsis A, Deplewski D, et al. Rat preputial sebocyte differentiation involves peroxisome proliferator-activated receptors. J Invest Dermatol 1999 Feb; 112(2): 226–32

    Article  PubMed  CAS  Google Scholar 

  42. Rosenfield RL, Deplewski D, Greene ME. Peroxisome proliferator-activated receptors and skin development. Horm Res 2000; 54(5–6): 269–74

    Article  PubMed  CAS  Google Scholar 

  43. Fujie T, Shikiji T, Uchida N, et al. Culture of cells derived from the human sebaceous gland under serum-free conditions without a biological feeder layer or specific matrices. Arch Dermatol Res 1996 Oct; 288(11): 703–8

    Article  PubMed  CAS  Google Scholar 

  44. Nishijima S, Kurokawa I, Katoh N, et al. The bacteriology of acne vulgaris and antimicrobial susceptibility of Propionibacterium acnes and Staphylococcus epidermidis isolated from acne lesions. J Dermatol 2000 May; 27(5): 318–23

    PubMed  CAS  Google Scholar 

  45. Burkhart CG, Burkhart CN, Lehmann PF. Acne: a review of immunologic and microbiologic factors. Postgrad Med J 1999 Jun; 75(884): 328–31

    PubMed  CAS  Google Scholar 

  46. Leyden JJ, McGinley KJ, Mills OH, et al. Age-related changes in resident bacterial flora of the human face. J Invest Dermatol 1975 Oct; 65(4): 379–81

    Article  PubMed  CAS  Google Scholar 

  47. McGinley KJ, Webster GF, Ruggieri MR, et al. Regional variations in density of cutaneous propionibacteria: correlation of Propionibacterium acnes with sebaceous secretion. J Clin Microbiol 1980 Nov; 12(5): 672–5

    PubMed  CAS  Google Scholar 

  48. Forssman T. Antibiotic resistance in acne patients under antibiotic treatment in comparison to an untreated control group with retrospective assessment of therapy. Curr Probl Dermatol 1995; 22: 91–7

    PubMed  CAS  Google Scholar 

  49. Holland KT, Greenman J, Cunliffe WJ. Growth of cutaneous propionibacteria on synthetic medium: growth yields and exoenzyme production. J Appl Bacteriol 1979 Dec; 47(3): 383–94

    Article  PubMed  CAS  Google Scholar 

  50. Shalita AR, Lee WL. Inflammatory acne. Dermatol Clin 1983; 1: 361–4

    Google Scholar 

  51. Saint-Leger D, Bague A, Lefebvre E, et al. A possible role for squalene in the pathogenesis of acne. II: in vivo study of squalene oxides in skin surface and intra-comedonal lipids of acne patients. Br J Dermatol 1986 May; 114(5): 543–52

    Article  PubMed  CAS  Google Scholar 

  52. Ingham E, Walters CE, Eady EA, et al. Inflammation in acne vulgaris: failure of skin micro-organisms to modulate keratinocyte interleukin 1α production in vitro. Dermatology 1998; 196(1): 86–8

    Article  PubMed  CAS  Google Scholar 

  53. Allaker RP, Greenman J, Osborne RH. The production of inflammatory compounds by Propionibacterium acnes and other skin organisms. Br J Dermatol 1987 Aug; 117(2): 175–83

    Article  PubMed  CAS  Google Scholar 

  54. Puhvel SM, Sakamoto M. The chemoattractant properties of comedonal components. J Invest Dermatol 1978 Nov; 71(5): 324–9

    Article  PubMed  CAS  Google Scholar 

  55. Leyden JJ, McGinley KJ, Vowels B. Propionibacterium acnes colonization in acne and nonacne. Dermatology 1998; 196(1): 55–8

    Article  PubMed  CAS  Google Scholar 

  56. Vowels BR, Yang S, Leyden JJ. Induction of proinflammatory cytokines by a soluble factor of Propionibacterium acnes: implications for chronic inflammatory acne. Infect Immun 1995 Aug; 63(8): 3158–65

    PubMed  CAS  Google Scholar 

  57. Webster GF, Leyden JJ. Characterization of serum-independent polymorphonuclear leukocyte chemotactic factors produced by Propionibacterium acnes. Inflammation 1980 Sep; 4(3): 261–9

    Article  PubMed  CAS  Google Scholar 

  58. Scott DG, Cunliffe WJ, Gowland G. Activation of complement: a mechanism for the inflammation in acne. Br J Dermatol 1979 Sep; 101(3): 315–20

    Article  PubMed  CAS  Google Scholar 

  59. Webster GF, Leyden JJ, Nilsson UR. Complement activation in acne vulgaris: consumption of complement by comedones. Infect Immun 1979 Oct; 26(1): 183–6

    PubMed  CAS  Google Scholar 

  60. Knop J, Bossecker T, Kovary PM. Chemotactic efficiency of various chemoattractants for polymorphonuclear leukocytes in inflammatory acne vulgaris. Arch Dermatol Res 1982; 274(3–4): 267–75

    Article  PubMed  CAS  Google Scholar 

  61. Terui T, Kato T, Tagami H. Stratum corneum activation of complement through the antibody-independent alternative pathway. J Invest Dermatol 1989 Apr; 92(4): 593–7

    Article  PubMed  CAS  Google Scholar 

  62. Webster GF. Inflammatory acne represents hypersensitivity to Propionibacterium acnes. Dermatology 1998; 196(1): 80–1

    Article  PubMed  CAS  Google Scholar 

  63. Ashbee HR, Muir SR, Cunliffe WJ, et al. IgG subclasses specific to Staphylococcus epidermis and Propionibacterium acnes in patients with acne vulgaris. Br J Dermatol 1997 May; 136(5): 730–3

    Article  PubMed  CAS  Google Scholar 

  64. Gowland G, Ward RM, Holland KT, et al. Cellular immunity to P acnes in the normal population and patients with acne vulgaris. Br J Dermatol 1978 Jul; 99(1): 43–7

    Article  PubMed  CAS  Google Scholar 

  65. Kersey P, Sussman M, Dahl M. Delayed skin test reactivity to Propionibacterium acnes correlates with severity of inflammation in acne vulgaris. Br J Dermatol 1980 Dec; 103(6): 651–5

    Article  PubMed  CAS  Google Scholar 

  66. Karvonen SL, Rasanen L, Cunliffe WJ, et al. Delayed hypersensitivity to Propionibacterium acnes in patients with severe nodular acne and acne fulminans. Dermatology 1994; 189(4): 344–9

    Article  PubMed  CAS  Google Scholar 

  67. Norris JF, Cunliffe WJ. A histological and immunocytochemical study of early acne lesions. Br J Dermatol 1988 May; 118(5): 651–9

    Article  PubMed  CAS  Google Scholar 

  68. Guy R, Green MR, Kealey T. Modeling acne in vitro. J Invest Dermatol 1996 Jan; 106(1): 176–82

    Article  PubMed  CAS  Google Scholar 

  69. Guy R, Kealey T. The effects of inflammatory cytokines on the isolated human sebaceous infundibulum. J Invest Dermatol 1998 Apr; 110(4): 410–5

    Article  PubMed  CAS  Google Scholar 

  70. Guy R, Kealey T. Modeling the infundibulum in acne. Dermatology 1998; 196(1): 32–7

    Article  PubMed  CAS  Google Scholar 

  71. Ingham E, Eady EA, Goodwin CE, et al. Pro-inflammatory levels of interleukin-1 alpha-like bioactivity are present in the majority of open comedones in acne vulgaris. J Invest Dermatol 1992 Jun; 98(6): 895–901

    Article  PubMed  CAS  Google Scholar 

  72. Anttila HIS, Reitamo S, Saurat JH. Interleukin 1 immunoreactivity in sebaceous glands. Br J Dermatol 1992 Dec; 127(6): 585–8

    Article  PubMed  CAS  Google Scholar 

  73. Hauser C, Saurat JH, Schmit A, et al. Interleukin 1 is present in normal human epidermis. J Immunol 1986 May; 136(9): 3317–21

    PubMed  CAS  Google Scholar 

  74. Downing DT, Stewart ME, Wertz PW, et al. The effect of sebum on epidermal lipid composition. In: Marks R, Plewig G, editors. Acne and related disorders. London: Dunitz, 1988: 57–62

    Google Scholar 

  75. Eller MS, Yaar M, Ostrom K, et al. A role for interleukin-1 in epidermal differentiation: regulation by expression of functional versus decoy receptors. J Cell Sci 1995 Aug; 108 (Pt 8): 2741–6

    PubMed  CAS  Google Scholar 

  76. Knutson DD. Ultrastructural observations in acne vulgaris: the normal sebaceous follicle and acne lesions. J Invest Dermatol 1974 Mar; 62(3): 288–307

    Article  PubMed  CAS  Google Scholar 

  77. Strauss JS, Kligman AM. The pathogenic dynamics of acne vulgaris. Arch Dermatol 1960; 82: 779–90

    Article  Google Scholar 

  78. Böhm M, Luger TA. The pilosebaceous unit is part of the skin immune system. Dermatology 1998; 196(1): 75–9

    Article  PubMed  Google Scholar 

  79. Plewig G. Follicular keratinization. J Invest Dermatol 1974 Mar; 62(3): 308–20

    Article  PubMed  CAS  Google Scholar 

  80. Reenstra WR, Yaar M, Gilchrest BA. Effect of donor age on epidermal growth factor processing in man. Exp Cell Res 1993 Nov; 209(1): 118–22

    Article  PubMed  CAS  Google Scholar 

  81. Zouboulis CC. Exploration of retinoid activity and the role of inflammation in acne: issues affecting the future directions for acne therapy. J Eur Acad Dermatol Venereol 2001; 15 Suppl. 3: 63–7

    Article  Google Scholar 

  82. Downing DT, Stewart ME, Wertz PW, et al. Essential fatty acids and acne. J Am Acad Dermatol 1986 Feb; 14 (2 Pt 1): 221–5

    Article  PubMed  CAS  Google Scholar 

  83. Ziboh VA, Miller CC, Cho Y. Metabolism of polyunsaturated fatty acids by skin epidermal enzymes: generation of anti-inflammatory and antiproliferative metabolites. Am J Clin Nutr 2000 Jan; 71 (1 Suppl.): 361S–6S

    PubMed  CAS  Google Scholar 

  84. Letawe C, Boone M, Pierard GE. Digital image analysis of the effect of topically applied linoleic acid on acne microcomedones. Clin Exp Dermatol 1998 Mar; 23(2): 56–8

    Article  PubMed  CAS  Google Scholar 

  85. Stewart ME. Sebaceous gland lipids. Semin Dermatol 1992 Jun; 11(2): 100–5

    PubMed  CAS  Google Scholar 

  86. Akamatsu H, Komura J, Miyachi Y, et al. Suppressive effects of linoleic acid on neutrophil oxygen metabolism and phagocytosis. J Invest Dermatol 1990 Sep; 95(3): 271–4

    Article  PubMed  CAS  Google Scholar 

  87. Duvic M, Chandraratna RA. Retinoid receptor selectivity: importance and clinical application in skin diseases and other diseases. Dermatol Ther 1998; 7: 7–14

    Google Scholar 

  88. Nagpal S, Chandraratna RA. Recent developments in receptor-selective retinoids. Curr Pharm Des 2000 Jun; 6(9): 919–31

    Article  PubMed  CAS  Google Scholar 

  89. Jetten AM. Multi-stage program of differentiation in human epidermal keratinocytes: regulation by retinoids. J Invest Dermatol 1990 Nov; 95(5): 44S–6S

    Article  Google Scholar 

  90. Fisher C, Blumenberg M, Tomic-Canic M. Retinoid receptors and keratinocytes. Crit Rev Oral Biol Med 1995; 6(4): 284–301

    Article  PubMed  CAS  Google Scholar 

  91. Zouboulis CC, Seltmann H, Neitzel H, et al. Establishment and characterization of an immortalized human sebaceous gland cell line (SZ95). J Invest Dermatol 1999 Dec; 113(6): 1011–20

    Article  PubMed  CAS  Google Scholar 

  92. Zouboulis CC, Seltmann H, Sass JO, et al. Retinoid signaling by all-trans retinoic acid and all-trans retinoyl-β-D-glucuronide is attenuated by simultaneous exposure of human keratinocytes to retinol. J Invest Dermatol 1999 Feb; 112(2): 157–64

    Article  PubMed  CAS  Google Scholar 

  93. Vahlquist A, Rollman O, Holland DB, et al. Isotretinoin treatment of severe acne affects the endogenous concentration of Vitamin A in sebaceous glands. J Invest Dermatol 1990 Apr; 94(4): 496–8

    Article  PubMed  CAS  Google Scholar 

  94. White GM. Acne therapy. Dis Mon 1999 Aug; 45(8): 301–30

    Article  PubMed  CAS  Google Scholar 

  95. Weisshaar E, Schramm M, Gollnick H. Familial nevoid sebaceous gland hyperplasia affecting three generations of a family. Eur J Dermatol 1999 Dec; 9(8): 621–3

    PubMed  CAS  Google Scholar 

  96. Gollnick H, Orfanos CE. Familial nevoid sebaceous hyperplasia with hyperandrogenism. In: Wilkinson DS, Mascaro JM, Orfanos CE, editors. Clinical Dermatology, the CMD Case Collection. World Congress of Dermatology; 1987 May 24–29; Berlin. Berlin: Schattauer Verlag, 1987: 350–2

    Google Scholar 

  97. Liddell K. A familial study of acne and eczema. Br J Dermatol 1976 Jun; 94: 633–7

    Article  PubMed  CAS  Google Scholar 

  98. Layton AM, Henderson CA, Cunliffe WJ. A clinical evaluation of acne scarring and its incidence. Clin Exp Dermatol 1994 Jul; 19(4): 303–8

    Article  PubMed  CAS  Google Scholar 

  99. Thiboutot D. New treatments and therapeutic strategies for acne. Arch Fam Med 2000 Feb; 9(2): 179–87

    Article  PubMed  CAS  Google Scholar 

  100. Zouboulis CC, Krieter A, Gollnick H, et al. Progressive differentiation of human sebocytes in vitro is characterized by increasing cell size and altering antigen expression and is upregulated by culture duration and retinoids. Exp Dermatol 1994 Aug; 3(4): 151–60

    Article  PubMed  CAS  Google Scholar 

  101. Millikan LE. Adapalene: an update on newer comparative studies between the various retinoids. Int J Dermatol 2000 Oct; 39(10): 784–9

    Article  PubMed  CAS  Google Scholar 

  102. Weiss JS. Current options for the topical treatment of acne vulgaris. Pediatr Dermatol 1997 Nov–Dec; 14(6): 480–8

    Article  PubMed  CAS  Google Scholar 

  103. Thielitz A, Helmdach M, Ropke EM, et al. Lipid analysis of follicular casts from cyanoacrylate strips as a new method for studying therapeutic effects of antiacne agents. Br J Dermatol 2001 Jul; 145(1): 19–27

    Article  PubMed  CAS  Google Scholar 

  104. Hensby C, Cavey D, Bouclier M, et al. The in vivo and in vitro anti-inflammatory activity of CD271: a new retinoid-like modulator of cell differentiation. Agents Actions 1990 Jan; 29(1–2): 56–8

    Article  PubMed  CAS  Google Scholar 

  105. Vega B, Ferret C, Jomard A, et al. Regulation of Toll-like receptor 2 expression by adapalene: implications for the treatment of inflammatory acne [poster P0156]. International Investigative Dermatology Meeting; 2003 Apr 30–May 4; Miami (FL)

  106. Shalita A, Weiss JS, Chalker DK, et al. A comparison of the efficacy and safety of adapalene gel 0.1% and tretinoin gel 0.025% in the treatment of acne vulgaris: a multicenter trial. J Am Acad Dermatol 1996 Mar; 34: 482–5

    Article  PubMed  CAS  Google Scholar 

  107. Verschoore M, Poncet M, Czernielewski J, et al. Adapalene 0.1% gel has low skin-irritation potential. J Am Acad Dermatol 1997 Jun; 36 Suppl.: S104–S9

    Article  PubMed  CAS  Google Scholar 

  108. Cunliffe WJ, Poncet M, Loesche C, et al. A comparison of the efficacy and tolerability of adapalene 0.1 % gel versus tretinoin 0.025% gel in patients with acne vulgaris: a meta-analysis of five randomized trials. Br J Dermatol 1998 Oct; 139 Suppl. 52: 48–56

    Article  Google Scholar 

  109. Caron D, Sorba V, Kerrouche N, et al. Split-face comparison of adapalene gel 0.1% and tretinoin 0.025% gel in acne patients. J Am Acad Dermatol 1997 Jun; 36 Suppl.: S110–S2

    Article  PubMed  CAS  Google Scholar 

  110. Grosshans E, Marks R, Mascaro JM, et al. Evaluation of clinical efficacy and safety of adapalene 0.1% gel versus tretinoin 0.025% gel in the treatment of acne vulgaris, with particular reference to the onset of action and impact on quality of life. Br J Dermatol 1998 Oct; 139 Suppl. 52: 26–33

    Article  Google Scholar 

  111. Gibson JR. Rationale for the development of new topical treatments for acne vulgaris. Cutis 1996 Jan; 57: 13–9

    PubMed  CAS  Google Scholar 

  112. Webster GF, Berson D, Stein LF, et al. Efficacy and tolerability of once-daily tazarotene 0.1% gel versus once-daily tretinoin 0.025% gel in the treatment of facial acne vulgaris: a randomised trial. Cutis 2001 Jun; 67: 4–9

    PubMed  CAS  Google Scholar 

  113. Leyden JJ, Tanghetti EA, Miller B, et al. Once-daily tazarotene 0.1 % gel versus once-daily tretinoin 0.1% microsponge gel for the treatment of facial acne vulgaris: a double-blind randomised trial. Cutis 2002 Feb; 69: 12–9

    PubMed  Google Scholar 

  114. Meynadier J, Alirezai M. Systemic antibiotics for acne. Dermatology 1998; 196(1): 135–9

    Article  PubMed  CAS  Google Scholar 

  115. Orfanos CE, Zouboulis CHC. Oral retinoids in the treatment of seborrhoea and acne. Dermatology 1998; 196(1): 140–7

    Article  PubMed  CAS  Google Scholar 

  116. O’Donoghue MN. Update on acne therapy. Dermatology Nursing 1999 Jun; 11(3): 205–8

    PubMed  Google Scholar 

  117. Beylot C, Doutre MS, Beylot-Barry M. Oral contraceptives and cyproterone acetate in female acne treatment. Dermatology 1998; 196(1): 148–52

    Article  PubMed  CAS  Google Scholar 

  118. Baur DA, Butler RCD. Current concepts in the pathogenesis and treatment of acne. J Oral Maxillofac Surg 1998; 56: 651–5

    Article  PubMed  CAS  Google Scholar 

  119. Placzek M, Degitz K, Schmidt H, et al. Acne fulminans in late-onset congenital adrenal hyperplasia. Lancet 1999 Aug; 354(9180): 739–40

    Article  PubMed  CAS  Google Scholar 

  120. Gollnick H, Schramm M. Topical therapy in acne. J Eur Acad Dermatol Venereol 1998 Sep; 11 Suppl. 1: S8–S12

    Article  PubMed  Google Scholar 

  121. Webster GF. Topical tretinoin in acne therapy. J Am Acad Dermatol 1998 Aug; 39 (2 Pt 3): S38–44

    Article  PubMed  CAS  Google Scholar 

  122. Rietschel RL, Duncan SH. Clindamycin phosphate used in combination with tretinoin in the treatment of acne. Acta Derm Venereol 1978; 58: 555–7

    Google Scholar 

  123. Kligman AM, Mills OH, McGinley KJ, et al. Acne therapy with tretinoin in combination with antibiotics. Acta Derm Venereol Suppl (Stockh) 1975; 74: 111–5

    CAS  Google Scholar 

  124. Hurwitz S. The combined effect of vitamin A acid and benzoyl peroxide in the treatment of acne. Cutis 1976; 17: 585–90

    PubMed  CAS  Google Scholar 

  125. Caron D, Sorba V, Clucas A, et al. Skin tolerance of adapalene 0.1% gel in combination with other topical antiacne treatments. J Am Acad Dermatol 1997; 36 (6 Pt 2): S113–S5

    Article  PubMed  CAS  Google Scholar 

  126. Eady EA. Bacterial resistance in acne. Dermatology 1998; 196(1): 59–66

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

Professor Gollnick has conducted clinical studies for Galderma, Schering Berlin (AG), Yamanouchi, Hoffmann-la Roche and Hermal Company. Preparation of this manuscript was supported by Galderma International.

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  1. University Clinic for Dermatology and Venereology, Ottovon-Guericke-University, Leipziger Str. 44, Magdeburg, D-39120, Germany

    Harald Gollnick

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  1. Harald Gollnick
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Correspondence to Harald Gollnick.

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Gollnick, H. Current Concepts of the Pathogenesis of Acne. Drugs 63, 1579–1596 (2003). https://doi.org/10.2165/00003495-200363150-00005

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  • DOI: https://doi.org/10.2165/00003495-200363150-00005

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