Comparative characteristics of patients with follicular occlusion syndrome and severe acne

Background. Follicular hyperkeratosis and chronic inflammation, driven by the activation of several cytokines that also contribute to acne pathogenesis, hold a central role in the pathogenesis of follicular occlusion syndrome (FOS). Objective. To perform a comparative clinical, metabolic, and genetic analysis of patients with FOS and severe acne. Material and methods. Among patients seeking dermatological consultation, 74 patients with FOS and 78 patients with severe acne were enrolled in the study. History taking, physical examination, analysis of laboratory data, and genetic testing for nucleotide sequence variants (NSVs) of the TNF-α, IL-1β, IL-4, IL-6, and IL-10 genes were performed. Results. Among patients with FOS, males predominated (72%). The age of disease onset was 22 [19; 29] years, whereas in patients with acne it was 15 [13; 19] years (p<0.05). In patients with FOS, hidradenitis suppurativa was detected in 19 (25.6%) cases, and folliculitis of the scalp in 34 (45.9%). Furthermore, two components of FOS were identified in 14 (18.9%) patients, three components in 6 (8.2%), and four components in 1 (1.4%). Atopic diseases were observed in 8.1% of cases among patients with FOS, and in 25.6% of those with severe acne. Subjects with FOS exhibited a significantly higher prevalence of overweight or obesity (12.2%), arterial hypertension (9.5%) and dyslipidemia (21.6%) (p<0.05). No differences in the NSVs of TNF-α, IL-1β, IL-4, IL-6, and IL-10 were found between the patient groups. Conclusion. Patients with FOS demonstrate a lower prevalence of atopic diseases and a higher prevalence of obesity, arterial hypertension, and dyslipidemia compared to those with severe acne. Genetic analysis did not reveal differences in the distribution of proinflammatory and anti-inflammatory cytokine gene NSVs despite clinical and comorbid differences. These findings emphasize the need to search for other biological markers that determine the development of these conditions.