By Gerd Plewig MD, Albert M. Kligman MD, PhD (auth.)
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Extra resources for Acne: Morphogenesis and Treatment
Knowledge is not nearly so substantive in humans but clinical observations are beginning to fill in the gaps. In hypothyroidism it has been shown that sebum production is low and can be increased by thyroxine. This will undoubtedly be the case in isolated gonadotropin deficiency. Low sebum levels occur in isolated ACTH deficiency. In acromegaly sebum secretion is increased, an effect which cannot be correlated with growth hormone. Hypophysectomy of course reduces sebum output in these patients.
J. invest. Derm. 54, 487-495 (1970). : The skin surface lipids of man compared with those of eighteen species of animals. J. invest. Derm. 51, 83-89 (1968). : Comparative chemistry of sebum. J. invest. Derm. 62, 257-267 (1974). : Sebaceous gland response in man to prolonged total caloric deprivation. l. invest. Derm. 55, 303--309 (1970). : Chemical composition of human skin surface lipids from birth to puberty. l. invest. Derm. 54, 139-144 (1970). 29 The Appearances of Sebum Above: Comedo Stained for Lipid The framework of a comedo is soaked with sebum.
Lipolysis is virtually complete wherever C. acnes is numerous as in seborrheic filaments or comedones. Free fatty acids are considerably more comedogenic than the triglycerides from which they derive. Therefore, sebum acted upon by C. acnes has a greater capacity to incite retention hyperkeratosis; (2) lipoidal extracts of the organisms itself are strongly comedogenic; (3) the commencement of the comedo is always preceeded by a huge massing of C. acnes in the canal. As regards the incitation of rupture: (1) The cysts of steatocystoma multiplex are sterile.