The pathogenesis of acne is multifactorial. The key factor is genetics. Acne develops as a result of an interplay of the following four factors:
Release of inflammatory mediators into the skin
Follicular hyperkeratinization with subsequent plugging of the follicle
Cutibacterium acnes (formerly Propionibacterium acnes) follicular colonization
Excess sebum production
Although the main underlying cause of acne is genetic predisposition, other aggravating factors are recognized. Medications that can promote acne development include steroids, lithium, some anticonvulsants, barbiturates, cyclosporine, tumor necrosis factor-alpha antagonists, multikinase inhibitors, testosterone, and iodides. Cosmetic agents and hair pomades may worsen acne. Congenital adrenal hyperplasia, polycystic ovary syndrome (PCOS), and other endocrine disorders associated with excess androgens may trigger the development of acne. Even pregnancy may cause a flare-up. Mechanical occlusion with headbands, shoulder pads, backpacks, or underwire bras can be aggravating factors. Excessive sunlight may either improve or flare acne. In any case, the ultraviolet exposure ages the skin.
During adolescence, acne is more common in males than in females. In adulthood, acne vulgaris is more common in women than in men.
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Cite this: William James. Fast Five Quiz: Acne Practice Essentials - Medscape - Jan 15, 2020.