Therapeutic Relevance of Sebum in the Pathophysiology of Acne Vulgaris

A study published in the Journal of Dermatological Treatment found that there are limited treatments targeting sebum production, particularly in its role in the pathophysiology of acne vulgaris (AV).

Sebum production and its role in the pathophysiology of AV have been long debated. Within the pilosebaceous unit, androgens stimulate sebocytes to produce sebum, which consists of various lipids, including mono-, di-, and triglycerides; fatty acids; squalene; cholesterol; cholesterol esters; and wax esters. Sebum plays a key role in skin functions, such as moisture retention, antimicrobial defense, and immune responses.

In acne pathogenesis, androgen-driven sebum production is critical, promoting Cutibacterium acnes (C. acnes) proliferation and triggering inflammatory and comedogenic pathways. Alterations in sebum composition, particularly increased levels of certain fatty acids, contribute to acne lesion formation. Some sebum lipids, when present in isolation, have comedogenic effects, further linking sebum changes with acne development. Regional differences in facial sebum production, along with patient factors like sex and age, also influence acne severity.

Currently, limited treatments specifically target sebum production in patients with acne. These include combined oral contraceptives and oral spironolactone (for female patients), as well as oral isotretinoin and topical clascoterone (cortexolone 17α-propionate). Further research into the underlying mechanisms of sebaceous gland alterations in acne is necessary to broaden therapeutic options and improve treatment outcomes for patients with AV.

Reference
Del Rosso JQ, Kircik L. The primary role of sebum in the pathophysiology of acne vulgaris and its therapeutic relevance in acne management. J Dermatolog Treat. 2024;35(1):2296855. doi:10.1080/09546634.2023.2296855