The relevance of sebum composition in the etiopathogeny of acne

Marisa Gonzaga da Cunha, Francisca Daza, Carlos D. Apparecida Machado Filho, Glaucia Luciano da Veiga, Fernando Fonseca


Acne vulgaris is an inflammatory disease that develops around the hair follicle. Many are the interconnected etiopathogenic factors involved, among which we can mention the increase in levels of androgen hormones, sebum hypersecretion, follicular hyperkeratosis with microcomedo formation, the proliferation of the bacteria Propionibacterium acnes (P. acnes) and the resulting inflammatory response. The way this bacterial growth occurs and how it is connected with the development of the inflammatory process have been themes of many clinical and experimental trials. Modifications in the sebum composition lead to a greater proliferation and differentiation of keratinocytes that obstruct the follicular ostium and favor the formation of comedones. On the other hand, these modifications alter the follicular hydration and facilitate the proliferation of the P. acnes, which not only produces chemotactic factors but also releases lipase that oxidizes the squalene. The oxidized squalene induces the formation of pro-inflammatory cytokines and boosts the innate immunity of keratinocytes and sebocytes, thus generating the inflammatory process. The aim of this study was to review the literature regarding the new concepts on the pathogenesis of acne.


Acne; Sebum composition; Review

Full Text:



Leon H, Kircik MD. Advances in the understanding of the pathogenesis of inflammatory acne. J Drugs Dermatol. 2016; 15: s7-s10.

Jeremy AH, Holland DB, Roberts SG, Thomson KF, Cunliffe WJ. Inflammatory events are involved in acne lesions initiation. J Invest Dermatol. 2003; 121: 20-27.

Zouboulis CC, Jourdan E, Picardo M. Acne is an inflammatory disease and alterations of sebum composition initiate acne lesions. JEADV. 2014 28: 527-532.

Cunha MG, Fonseca FLA, Machado CA. Androgenic hormone profile of adult women with acne. Dermatology. 2013; 226: 167-171.

Tilles G. Acne pathogenesis: history of concepts. Dermatology. 2014; 229: 1-46.

Picardo M, Ottaviani M, Camera E. Mastrofrancesco A. Special focus review - sebaceous gland lipids. Dermato-Endocrinol. 2009; 1(2): 68-71.

Das S, Reynolds RV. Recent advances in acne pathogenesis: implications for therapy. Am J Clin Dermatol. 2014; 15: 479-488.

Kang S, Cho S, Chung JH, Hammerberg C, Fisher GJ, Voorhees JJ. Inflammation and extracellular matrix degradation mediated by activated transcription factors nuclear factor-κ band activator protein-1 in inflammatory acne lesions in vivo. Am J Pathol. 2005; 166: 1691-1699.

Ottaviani M, Camera E, Picardo M. Lipid mediators in acne. Mediators Inflamm. 2010; 2010: 858176.

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.

Thiboutot D. Regulation of human sebaceous glands. J Invest Dermatol. 2004; 123: 1-12.

Stewart ME, Grahek MO, Cambier LS, Wertz PW, Downing DT. Dilutional effect of increased sebaceous gland activity on the proportion of linoleic acid in sebaceous wax esters and in epidermal acylceramides. J Invest Dermatol. 1986; 87: 733-736.

Pappas A, Johnsen S, Liu JC, Eisinger M. Sebum analysis of individuals with and without acne Dermato-Endocrinology. 2009; 1(3): 157-161.

Bickers DR, Athar M. Oxidative stress in the pathogenesis of skin disease. J Invest Dermatol. 2006; 126: 2565-2575.

Niki E. Lipid oxidation in the skin. Free Radical Res. 2015; 49: 827-834.

Capitanio B, Lora V, Ludovici M, Sinagra JL, Ottaviani M, Mastrofrancesco A, et al. Modulation of sebum oxidation and interleukin-1α levels associates with clinical improvement of mild comedonal acne. J Eur Acad Dermatol Venereol. 2014; 28: 1792-1797.

Ottaviani M, Alestas T, Flori E, Mastrofrancesco A, Zouboulis CC, Picardo M. Peroxidated squalene induces the production of inflammatory mediators in HaCaT keratinocytes: a possible role in acne vulgaris. J Invest Dermatol. 2006; 126: 2430-2437.

Pham DM, Boussouira B, Moyal D, Nguyen QL. Oxidization of squalene, a human skin lipd: a new and reliable marker of environmental pollution studies. Int J Cosmet Sci. 2015; 37: 357-365.

Mills OH, Criscito MC, Schlesinger TE, Verdicchio R, Szoke E. Addressing free radical oxidation in acne vulgaris. J Clin Aesthet Dermatol. 2016; 9: 25-30.

Neufang G, Fürstenberger G, Heidt M, Marks F, Müller-Decker K. Abnormal differentiation of epidermis in Transgenic mice constitutively expressing cyclooxygenase-2 in skin. Proc Natl Acad Sci USA. 2001; 98: 7629-7634.

Chiba K, Yoshizawa K, Makino I, Kawakami K, Onoue M. Comedogenicity of squalene monohydroperoxide in the skin after topical application. J Toxicol Sci. 2000; 25: 77-83.

Motoyoshi K. Enhanced comedo formation in rabbit ear skin by squalene and oleic acid peroxides. Br J Dermatol. 1983; 109: 191-198.


  • There are currently no refbacks.