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Acne vulgaris

Abstract

Acne vulgaris is a chronic inflammatory disease — rather than a natural part of the life cycle as colloquially viewed — of the pilosebaceous unit (comprising the hair follicle, hair shaft and sebaceous gland) and is among the most common dermatological conditions worldwide. Some of the key mechanisms involved in the development of acne include disturbed sebaceous gland activity associated with hyperseborrhoea (that is, increased sebum production) and alterations in sebum fatty acid composition, dysregulation of the hormone microenvironment, interaction with neuropeptides, follicular hyperkeratinization, induction of inflammation and dysfunction of the innate and adaptive immunity. Grading of acne involves lesion counting and photographic methods. However, there is a lack of consensus on the exact grading criteria, which hampers the conduction and comparison of randomized controlled clinical trials evaluating treatments. Prevention of acne relies on the successful management of modifiable risk factors, such as underlying systemic diseases and lifestyle factors. Several treatments are available, but guidelines suffer from a lack of data to make evidence-based recommendations. In addition, the complex combination treatment regimens required to target different aspects of acne pathophysiology lead to poor adherence, which undermines treatment success. Acne commonly causes scarring and reduces the quality of life of patients. New treatment options with a shift towards targeting the early processes involved in acne development instead of suppressing the effects of end products will enhance our ability to improve the outcomes for patients with acne.

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Figure 1: Acne formation.
Figure 2: The ten most prevalent diseases according to the Global Burden of Disease study.
Figure 3: Tangled network of four core events in acne formation.
Figure 4: Pathophysiological processes involved in acne vulgaris.
Figure 5: Clinical presentation of acne vulgaris.
Figure 6: Acne conglobata.

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Authors

Contributions

Introduction (S.M.T., C.C.Z. and S.R.F.); Epidemiology (S.M.T., C.C.Z. and S.R.F.); Mechanisms/pathophysiology (S.M.T, E.M., R.G., C.D., C.C.Z. and S.R.F.); Diagnosis, screening and prevention (S.M.T., E.M., R.G., C.D., C.C.Z. and S.R.F.); Management (S.M.T., C.C.Z. and S.R.F.); Quality of life (S.M.T., E.M., R.G., C.D., C.C.Z. and S.R.F.); Outlook (S.M.T., C.C.Z. and S.R.F.); overview of Primer (S.R.F.). S.M.T. and E.M. contributed equally as first authors. S.R.F. and C.C.Z. contributed equally as senior authors.

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Correspondence to Steven R. Feldman.

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Competing interests

S.M.T. has no conflicts to disclose. E.M. has received an honorarium and a grant from Immundiagnostik. R.G. is a consultant for L'Oreal, and received honoraria as a speaker for Bioderma, Stiefel/GlaxoSmithKline and LEO Pharma. C.D. has received an honorarium as a speaker for Stiefel/GlaxoSmithKline. S.R.F. is a speaker for Janssen and Taro; he is also a consultant and speaker for Galderma, Stiefel/GlaxoSmithKline, Abbott Laboratories and LEO Pharma. S.R.F. has received grants from Galderma, Janssen, Abbott Laboratories, Amgen, Stiefel/GlaxoSmithKline, Celgene and Anacor. S.R.F. is also a consultant for Amgen, Baxter, Caremark, Gerson Lehrman Group, Guidepoint Global, HanAll Pharmaceutical, Kikaku, Eli Lilly, Merck, Merz, Mylan, Novartis, Pfizer, Qurient, Suncare Research and Xenoport. S.R.F. is on an advisory board for Pfizer. S.R.F. is also the founder of and holds stock in Causa Research, and holds stock and is the majority owner in Medical Quality Enhancement Corporation, and he receives royalties from UpToDate and Xlibris. The Center for Dermatology Research, Wake Forest School of Medicine, North Carolina, USA, is supported by an unrestricted educational grant from Galderma Laboratories. C.C.Z. has received honoraria from AbbVie, Almirall, Basilea, Bayer Health Care, Bioderma, Biogen-Idec, Dermira, Galderma, General Topics, Glenmark, LEO Pharma, Philips Lifestyle, Pierre Fabre, Stiefel/GlaxoSmithKline, Vichy and Xenon for participation on advisory boards, or as a consultant, investigator or speaker. The Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany, have received grants from AbbVie, AstraZeneca, Bioderma, Biogen-Idec, Bristol-Meyers Squibb, Immundiagnostik, Intendis, LVMH, Merz, Novartis, Pierre Fabre, and UCB for the participation of C.C.Z. as an investigator, or on advisory boards.

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Tuchayi, S., Makrantonaki, E., Ganceviciene, R. et al. Acne vulgaris. Nat Rev Dis Primers 1, 15029 (2015). https://doi.org/10.1038/nrdp.2015.29

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