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Aktuelle Dermatologie 2005; 31(10): 440-447
DOI: 10.1055/s-2005-870171
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Aktuelle Vorstellungen zur Entstehung von Komedonen (Komedogenese) und Implikationen für eine Pathogenese-orientierte Aknetherapie

Recent Understandings of the Development of Comedones (Comedogenesis) and Implications for Pathogenesis-Related Acne TherapyT.  Jansen1 , J.  Dissemond1 , S.  Grabbe1
  • 1Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie der Universität Essen (Direktor: Prof. Dr. S. Grabbe)
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Publication History

Publication Date:
26 September 2005 (online)

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Zusammenfassung

Für die Entstehung von Komedonen bei der Akne werden verschiedene pathogenetische Faktoren verantwortlich gemacht. Zu den endogenen Faktoren zählen P. acnes, Interleukin-1α, androgene Effekte auf die Follikelkeratinozyten, Veränderungen des Retinol- oder Dehydroretinolgehaltes der Talgdrüse, ein relativer Linolsäuremangel im Follikel sowie komedogene Bestandteile des Talges. Exogene Faktoren wie komedogene Substanzen in Pflegemitteln und Kosmetika tragen zur Komedogenese bei. Das Zusammenspiel endogener und exogener Faktoren führt zu einer gestörten Verhornung (Proliferations-Retentions-Hyperkeratose) im Infrainfundibulum des Follikelausführungsganges. Eine Pathogenese-orientierte Aknetherapie ist auf die Normalisierung der epithelialen Verhornung mit Beseitigung der Komedonen und Verhinderung ihrer Neubildung ausgerichtet.

Abstract

A variety of pathogenetic factors may be responsible for the development of comedones in acne. Endogenic factors include P. acnes, interleukin-1α, androgenic effects on follicular keratinocytes, changes of the retinol or dehydroretinol content of the sebaceous gland, a relative linoleic acid deficiency within the follicle, and comedogenic sebum components. Exogenic factors such as comedogenic ingredients of skin care products and cosmetics contribute to comedogenesis. Endogenic and exogenic factors lead to disturbed keratinization (proliferation-retention hyperkeratosis) of the follicular infrainfundibulum. Pathogenesis-related acne therapy will normalize epithelial keratinization with clearing and prevention of comedones.

Literatur

  • 1 Aldana O L, Holland D B, Cunliffe W J. Variation in pilosebaceous duct keratinocyte proliferation in acne patients.  Dermatology. 1998;  196 98-99
    CrossrefPubMedGoogle Scholar
  • 2 Allaker R P, Greenman J, Osborne R H. The production of inflammatory compounds by Propionibacterium acnes and other skin organisms.  Br J Dermatol. 1987;  117 175-183
    PubMedGoogle Scholar
  • 3 Anderson D N, Callender V D, Del Rosso J Q, Tanghetti E A, Zane L T. Topical tazarotene in acne vulgaris: treatment approaches.  Cutis. 2004;  74 (Suppl 4) 16-21
    PubMedGoogle Scholar
  • 4 Aversa A J, Nagy R. Localized comedones following radiation therapy.  Cutis. 1983;  31 296-303
    PubMedGoogle Scholar
  • 5 Choudhry R, Hodgkins M B, Van der Kwast T H, Brinkmann A O, Boersma W J. Localization of androgen receptors in human skin by immunocytochemistry: implications for the hormonal regulation of hair growth, sebaceous glands and sweat glands.  J Endocrinol. 1992;  133 467-475
    PubMedGoogle Scholar
  • 6 Cunliffe W J, Forster R A. Androgen control of the pilosebaceous duct?.  Br J Dermatol. 1987;  116 449
    PubMedGoogle Scholar
  • 7 Cunliffe W J, Holland D B, Clark S M, Stables G I. Comedogenesis: some new aetiological, clinical and therapeutic strategies.  Br J Dermatol. 2000;  142 1084-1091
    CrossrefPubMedGoogle Scholar
  • 8 Cunliffe W J, Perera W D, Tan S G, Williams M, Williams S. Pilo-sebaceous duct physiology. II. The effect of keratin hydration on sebum excretion rate.  Br J Dermatol. 1976;  94 431-434
    PubMedGoogle Scholar
  • 9 Downing D T, Stewart M E, Wertz P W, Strauss J S. Essential fatty acids and acne.  J Am Acad Dermatol. 1986;  14 221-225
    PubMedGoogle Scholar
  • 10 Fitton A, Goa K L. Azelaic acid. A review of its pharmacological properties and therapeutic efficacy in acne and hyperpigmentary skin disorders.  Drugs. 1991;  41 780-798
    CrossrefPubMedGoogle Scholar
  • 11 Frank S B. Is the rabbit ear, in its present state, prophetic of acnegenicity?.  J Am Acad Dermatol. 1982;  6 373-377
    PubMedGoogle Scholar
  • 12 Fujie T, Shikiji T, Uchida N, Urano Y, Nagae H, Arase S. Culture of cells derived from the human sebaceous gland under serum-free conditions without a biological feeder layer or specific matrices.  Arch Dermatol Res. 1996;  288 703-708
    CrossrefPubMedGoogle Scholar
  • 13 Fulton J E Jr. Comedogenicity and irritancy of commonly used ingredients in skin care products.  J Soc Cosmet Chem. 1989;  40 321-333
    PubMedGoogle Scholar
  • 14 Guy R, Kealey T. Modelling the infundibulum in acne.  Dermatology. 1998;  196 32-37
    CrossrefPubMedGoogle Scholar
  • 15 Guy R, Kealey T. The effects of inflammatory cytokines on the isolated human sebaceous infundibulum.  J Invest Dermatol. 1998;  110 410-415
    CrossrefPubMedGoogle Scholar
  • 16 Hay J B, Hodgins M B. Distribution of androgen metabolizing enzymes in isolated tissues of human forehead and axillary skin.  J Endocrinol. 1978;  79 29-39
    PubMedGoogle Scholar
  • 17 Holland D B, Aldana O L, Cunliffe W J. Abnormal integrin expression in acne.  J Invest Dermatol. 1998;  110 559 (Abstract)
    PubMedGoogle Scholar
  • 18 Hughes B R, Morris C, Cunliffe W J, Leigh I M. Keratin expression in pilosebaceous epithelia in truncal skin of acne patients.  Br J Dermatol. 1996;  134 247-256
    CrossrefPubMedGoogle Scholar
  • 19 Hurwitz R M. Steroid acne.  J Am Acad Dermatol. 1989;  21 1179-1181
    PubMedGoogle Scholar
  • 20 Ingham E, Eady E A, Goodwin C E, Cove J H, Cunliffe W J. Pro-inflammatory levels of interleukin-1α-like bioactivity are present in the majority of open comedones in acne vulgaris.  J Invest Dermatol. 1992;  98 895-901
    CrossrefPubMedGoogle Scholar
  • 21 Ingham E, Walters C E, Eady E A, Cove J H, Kearney J N, Cunliffe W J. Inflammation in acne vulgaris: failure of skin micro-organisms to modulate keratinocyte interleukin 1α production in vitro.  Dermatology. 1998;  196 86-88
    CrossrefPubMedGoogle Scholar
  • 22 Jansen T, Plewig G, Kligman A M. Pathophysiology of acne.  Dermatol Ther. 1998;  6 7-17
    PubMedGoogle Scholar
  • 23 Kanaar P. Follicular-keratogenic properties of fatty acids in the external ear canal of the rabbit.  Dermatologica. 1971;  142 14-22
    PubMedGoogle Scholar
  • 24 Kealey T. Hypovitaminosis A of follicular duct as cause of acne vulgaris.  Lancet. 1988;  II 449
    PubMedGoogle Scholar
  • 25 Kligman A M. An overview of acne.  J Invest Dermatol. 1974;  62 268-287
    CrossrefPubMedGoogle Scholar
  • 26 Kligman A M. A critical look at acne cosmetica.  J Cutan Aging Cosmet Dermatol. 1988/89;  1 109-114
    PubMedGoogle Scholar
  • 27 Knaggs H E, Holland D B, Morris C, Wood E J, Cunliffe W J. Quantification of cellular proliferation in acne using the monoclonal antibody Ki-67.  J Invest Dermatol. 1994;  102 89-92
    CrossrefPubMedGoogle Scholar
  • 28 Knaggs H E, Hughes B R, Morris C, Wood E J, Holland D B, Cunliffe W J. Immunohistochemical study of desmosomes in acne vulgaris.  Br J Dermatol. 1994;  130 731-737
    PubMedGoogle Scholar
  • 29 Knaggs H E, Layton A M, Morris C, Wood E J, Holland D B, Cunliffe W J. Investigation of the expression of the extracellular matrix glycoproteins tenascin and fibronectin during acne vulgaris.  Br J Dermatol. 1994;  130 576-582
    PubMedGoogle Scholar
  • 30 Knutson D. Ultrastructural observations in acne vulgaris: the normal sebaceous follicle and acne lesions.  J Invest Dermatol. 1974;  62 288-307
    CrossrefPubMedGoogle Scholar
  • 31 Lamberg S I. The course of acne vulgaris in military personnel stationed in Southeast Asia.  Cutis. 1971;  7 655-660
    PubMedGoogle Scholar
  • 32 Lavker R M, Leyden J J, McGinley K J. The relationship between bacteria and the abnormal follicular keratinization in acne vulgaris.  J Invest Dermatol. 1981;  77 25-330
    PubMedGoogle Scholar
  • 33 Leeming J P, Holland K T, Cunliffe W J. The pathological and ecological significance of microorganisms colonising acne vulgaris comedones.  J Med Microbiol. 1985;  20 11-16
    PubMedGoogle Scholar
  • 34 Leyden J J. New understandings of the pathogenesis of acne.  J Am Acad Dermatol. 1995;  32 S15-S25
    CrossrefPubMedGoogle Scholar
  • 35 Leyden J J. A review of the use of combination therapies for the treatment of acne vulgaris.  J Am Acad Dermatol. 2003;  49 (Suppl 3) S200-S210
    CrossrefPubMedGoogle Scholar
  • 36 Melnik B, Kinner T, Plewig G. Influence of oral isotretinoin treatment on the composition of comedonal lipids: implications for comedogenesis in acne vulgaris.  Arch Dermatol Res. 1988;  280 97-102
    CrossrefPubMedGoogle Scholar
  • 37 Milewich L, Sontheimer R D, Herndon J H Jr. Steroid sulfatase activity in epidermis of acne-prone and non-acne-prone skin of patients with acne vulgaris.  Arch Dermatol. 1990;  126 1312-1314
    CrossrefPubMedGoogle Scholar
  • 38 Motoyoshi K. Enhanced comedo formation in rabbit ear skin by squalene and oleic acid peroxides.  Br J Dermatol. 1983;  109 191-198
    PubMedGoogle Scholar
  • 39 Norris J F, Cunliffe W J. A histological and immunocytochemical study of early acne lesions.  Br J Dermatol. 1988;  118 651-659
    PubMedGoogle Scholar
  • 40 Paraskevaidis A, Drakoulis N, Roots I, Orfanos C E, Zouboulis C C. Polymorphisms in the human cytochrome P-450 1A1 gene (CYP1A1) as a factor for developing acne.  Dermatology. 1998;  196 171-175
    CrossrefPubMedGoogle Scholar
  • 41 Patterson W M, Fox M D, Schwartz R A. Favre-Racouchot disease.  Int J Dermatol. 2004;  43 167-169
    CrossrefPubMedGoogle Scholar
  • 42 Pawin H, Beylot C, Chivot M, Faure M, Poli F, Revuz J, Dréno B. Physiopathology of acne vulgaris: recent data, new understanding of the treatments.  Eur J Dermatol. 2004;  14 4-12
    PubMedGoogle Scholar
  • 43 Plewig G. Folicular keratinization.  J Invest Dermatol. 1974;  62 308-320
    CrossrefPubMedGoogle Scholar
  • 44 Plewig G, Fulton J E Jr, Kligman A M. Pomade acne.  Arch Dermatol. 1970;  101 580
    CrossrefPubMedGoogle Scholar
  • 45 Plewig G, Fulton J E Jr, Kligman A M. Cellular dynamics of comedo formation in acne vulgaris.  Arch Dermatol Forsch. 1971;  242 12-29
    CrossrefPubMedGoogle Scholar
  • 46 Rigopoulos D, Ioannides D, Kalogeromitros D, Katsambas A D. Comparison of topical retinoids in the treatment of acne.  Clin Dermatol. 2004;  22 408-411
    PubMedGoogle Scholar
  • 47 Saint-Leger D, Bague A, Lefebvre E, Cohen E, Chivot M. A possible role for squalene in the pathogenesis of acne. II. In vivo study of squalene oxides in skin surface and intra-comedonal lipids of acne patients.  Br J Dermatol. 1986;  114 543-552
    PubMedGoogle Scholar
  • 48 Shalita A R, Harris H. Comedo extraction.  Arch Dermatol. 1972;  105 759-760
    CrossrefPubMedGoogle Scholar
  • 49 Shroot B, Michel S. Pharmacology and chemistry of adapalene.  J Am Acad Dermatol. 1997;  36 (Suppl 6) S96-S103
    PubMedGoogle Scholar
  • 50 Stewart M E, Greenwood R, Cunliffe W J, Strauss J S, Downing D T. Effect of cyproterone acetate-ethinyl estradiol treatment on the proportions of linoleic and sebaleic acids in various skin surface lipid classes.  Arch Dermatol Res. 1986;  278 481-485
    CrossrefPubMedGoogle Scholar
  • 51 Stewart M E, Wertz P W, Crahek M O. Relationship between sebum secretion rates and the concentration of linoleate in sebum and epidermal lipids.  Clin Res. 1985;  33 684-688
    PubMedGoogle Scholar
  • 52 Thiboutot D M, Knaggs H, Gilliland K, Hagari S. Acitivity of type 1 5α-reductase is greater in the follicular infrainfundibulum compared with the epidermis.  Br J Dermatol. 1997;  136 166-171
    CrossrefPubMedGoogle Scholar
  • 53 Thiboutot D M, Knaggs H, Gilliland K, Lin G. Activity of 5-alpha-reductase and 17-beta-hydroxysteroid dehydrogenase in the infundibulum of subjects with and without acne vulgaris.  Dermatology. 1998;  196 38-42
    CrossrefPubMedGoogle Scholar
  • 54 Thielitz A, Helmdach M, Röpke E M, Gollnick H. Lipid analysis of follicular casts from cyanoacrylate strips as a new method for studying therapeutic effects of antiacne agents.  Br J Dermatol. 2001;  145 19-27
    CrossrefPubMedGoogle Scholar
  • 55 Tindall J P. Chloracne and chloracnegens.  J Am Acad Dermatol. 1985;  13 539-558
    PubMedGoogle Scholar
  • 56 Vahlquist A, Rollman O, Holland D B, Cunliffe W J. Isotretinoin treatment of severe acne affects the endogenous concentration of vitamin A in sebaceous glands.  J Invest Dermatol. 1990;  94 496-498
    CrossrefPubMedGoogle Scholar
  • 57 Vega B, Jomard A, Michel S. Regulation of human monocyte Toll-like receptor 2 (TLR2) expression by adapalene.  J Eur Acad Dermatol Venereol. 2002;  16 123-124 (Abstract)
    PubMedGoogle Scholar
  • 58 Wakita H, Matsushita K, Nishimura K, Tokura Y, Furukawa F, Takigawa M. Sphingosylphosphorylcholine stimulates proliferation and upregulates cell surface-associated plasminogen activator activity in cultured human keratinocytes.  J Invest Dermatol. 1998;  110 253-258
    CrossrefPubMedGoogle Scholar
  • 59 Wertz P W, Miethke M C, Long S A, Strauss J S, Downing D T. The composition of the ceramides from human stratum corneum and from comedones.  J Invest Dermatol. 1985;  84 410-412
    PubMedGoogle Scholar
  • 60 Williams M, Cunliffe W J, Gould D. Pilo-sebaceous duct physiology. I. Effect of hydration on pilo-sebaceous duct orifice.  Br J Dermatol. 1974;  90 631-635
    PubMedGoogle Scholar
  • 61 Wolff H H, Plewig G, Braun-Falco O. Ultrastructure of human sebaceous follicles and comedones following treatment with vitamin A acid.  Acta Derm Venereol (Stockh). 1975;  74 (Suppl) 99-100
    PubMedGoogle Scholar
  • 62 Woo-Sam P C. A quantitative study of membrane coating granules in follicles undergoing experimental comedo formation.  Br J Dermatol. 1978;  99 387-394
    PubMedGoogle Scholar
  • 63 Zouboulis C C, Xia L, Akamatsu H, Seltmann H, Fritsch M, Hornemann S, Ruhl R, Chen W, Nau H, Orfanos C E. The human sebocyte culture model provides new insights into development and management of seborrhoea and acne.  Dermatology. 1998;  196 21-31
    CrossrefPubMedGoogle Scholar

Dr. Thomas Jansen

Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie · Universität Essen

Hufelandstraße 55 · 45122 Essen

Email: thomas.jansen@medizin.uni-essen.de

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