Abnormal follicular keratinization: follicular wall cells fail to desquamate to the surface in the normal manner.
• Sebum over production secondary to androgen
• Propionibacterium acnes infection; they grow in the sebum-cell mixture. comedone extraction, intralesional cortisone injection (for papulonodules, cysts), oral contraceptives (esp. antiandrogenic such as cyproterone acetate), photodynamic therapy, spironolactone (reduces androgen production; 50
– 200 mg/day), dermabrasion
- Patients should be forewarned of acne exacerbations in the first month of systemic therapy as deep-seated acne comes to the surface. Also, systemic therapy can required 6 week before benefits are noted.