Comedogenesis: some new aetiological, clinical and therapeutic strategies

• Published in: British journal of dermatology (1951) Vol. 142; no. 6; pp. 1084 - 1091
• Main Authors: Cunliffe, W.J., Holland, D.B., Clark, S.M., Stables, G.I.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01-06-2000; Blackwell; Oxford University Press
• Subjects: Acne Vulgaris - etiology; Acne Vulgaris - pathology; Acne Vulgaris - therapy; Biological and medical sciences; Cautery; cycling; Dermatology; Humans; hyperproliferation; macrocomedones; Medical sciences; microcomedones; Retinoids - therapeutic use; review therapy; Skin involvement in other diseases. Miscellaneous. General aspects; Human; Skin disease; Review; Pathophysiology; Comedo; Acne
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1046/j.1365-2133.2000.03531.x

Hypercornification is an early feature of acne and precedes inflammation. It is associated with ductal hyperproliferation and there are many controlling factors such as androgens, retinoids and cytokines. Cycling of normal follicles and of comedones may explain the natural resolution of comedones and, in the longer term, resolution of the disease itself. There is a need to tailor treatment according to comedonal type. Suboptimal therapy can often result from inappropriate assessments of comedones, especially microcomedones, missed comedones, sandpaper comedones, submarine comedones and macrocomedones. Macrocomedones can produce devastating acne flares, particularly if patients are inappropriately prescribed oral isotretinoin. Gentle cautery under topical local anaesthesia is a useful therapy in the treatment of such lesions. The newer retinoids and new formulations of all‐trans‐retinoic acid show a better benefit/risk ratio. Evidence‐based studies are required to allow adequate comparisons.