How is pathogenesis of acne?

• Key factors are follicular keratinization, androgens, and Cutibacterium acnes • Follicular plugging (comedone) prevents drainage of sebum • Androgens (quantitatively and qualitatively normal in serum) stimulate sebaceous glands to produce more sebum • Bacterial (C. acnes) lipase converts lipids to fatty acids and produces proinflammatory mediators (ILI, TNFα), which lead to an inflammatory response • Distended follicle walls break; sebum, lipids, fatty acids, keratin, and bacteria enter the dermis, provoking an inflammatory and foreign body response. Intense inflammation leads to scars