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Acne Vulgaris Pathophysiology

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  1. Androgen Mediated Sebum Production
    1. Sebum composition
      1. Triglycerides
      2. Cholesterol esters
      3. Waxes
      4. Fatty acids
    2. Sebum Effects
      1. Drains to skin surface via pilosebaceous canal
      2. Excellent growth medium for Propionibacterium acnes
  2. Keratinous Obstruction of sebaceous follicle outlet
    1. Pre-Puberty Sebaceous follicles
      1. Lobulated glands empty into pilosebaceous canal
      2. Follicles most dense on face, back and chest
      3. Inactive until Puberty
    2. Post-Puberty Sebaceous follicles
      1. Androgen production increases
      2. Stimulates sebaceous follicles to secrete sebum
  3. Comedones form from keratin and sebum collection
    1. Open Comedones (Black heads)
      1. Combination of sebum and keratin
      2. Melanin gives them the black color
      3. Seldom become inflamed
    2. Closed Comedones (White heads)
      1. Do not communicate with the skin surface
      2. Block pilosebaceous canal
      3. Encourage Anaerobic Bacteria to grow
      4. Propionibacterium acnes fuels inflammatory process
        1. Lipase secretion lyses Triglycerides
        2. Free Fatty acids fuel local irritation
      5. Closed comedones progress to inflammatory lesions
  4. Bacterial Colonization of trapped sebum
    1. Propionibacterium acnes bacteria colonizes sebum
      1. Secretes a Lipase that hydrolyzes sebum
        1. Converts Triglycerides into free fatty acids
        2. Free fatty acids irritate local cells
  5. Inflammatory reaction (usually in closed comedones)
    1. Papules
    2. Pustules
    3. Nodules
    4. Cysts

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