Topical treatment of acne vulgaris: Retinoids and cutaneous irritation

Acne vulgaris is a disease of sebaceous follicles that involves a multifactored pathophysiology. 1 Leyden JJ. Therapy for acne vulgaris. N Engl J Med. 1997; 336: 1156-1162 Crossref PubMed Scopus (232) Google Scholar Excessive sebum production, combined with abnormal desquamation of follicular epithelium, leads to an accumulation of these materials such that the lumina of sebaceous follicles become distended. This precursor, microscopic stage is known as a microcomedo. In this environment, Propionibacterium acnes proliferates and its production of proinflammatory chemotactic and cytokine factors is responsible for the inflammation of acne. 2 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; 63: 3158-3165 PubMed Google Scholar , 3 Webster GF Leyden JJ. Characterization of serum-independent polymorphonuclear leukocyte chemotactic factors produced by Propionibacterium acnes. Inflammation. 1996; 4: 362-384 Google Scholar , 4 Webster GF Leyden JJ Nilson R. Complement activation in acne vulgaris: consumption of complement by comedones. Infect Immun. 1979; 26: 183-186 PubMed Google Scholar