Whiting D A
West J Med. 1979 Dec;131(6):551-7.
The cause of acne is still obscure, but genetic predisposition, sebaceous overactivity, overgrowth of bacterial flora and exposure to comedogenic substances are all significant factors. Acne lesions occur mainly in sebaceous follicles, which are characterized by deep follicular canals and large sebaceous glands. The associated seborrhea is not due to a circulatory excess of androgens but may be caused by a local amplification of androgenic activity. This, in turn, may be due to large numbers of androgen receptors and a high concentration of enzymes such as 17beta-hydroxysteroid dehydrogenase, within the sebaceous gland itself. Hyperkeratosis of the retention type in the pilary infrainfundibulum obstructs the outflow of sebum and keratin flakes. This favors the proliferation of Propionibacterium acnes which may initiate inflammation in microcomedos and lead to formation of pustules, papules or nodules. Topical therapy with tretinoin, benzoyl peroxide and antibiotics such as clindamycin is widely used today. Oral tetracyclines and other chemotherapeutic agents remain necessary in severe cases.
痤疮的病因仍不明确，但遗传易感性、皮脂腺过度活跃、细菌菌群过度生长以及接触致粉刺物质都是重要因素。痤疮损害主要发生在皮脂腺毛囊，其特征是毛囊管较深且皮脂腺较大。相关的皮脂溢并非由于雄激素循环过量，而是可能由局部雄激素活性增强所致。这反过来可能是由于皮脂腺自身存在大量雄激素受体以及高浓度的酶，如17β - 羟类固醇脱氢酶。毛囊漏斗部潴留型角化过度阻碍了皮脂和角质鳞片的排出。这有利于痤疮丙酸杆菌的增殖，痤疮丙酸杆菌可能引发微粉刺炎症并导致脓疱、丘疹或结节的形成。如今广泛使用外用维甲酸、过氧化苯甲酰以及克林霉素等抗生素进行治疗。严重病例仍需口服四环素和其他化疗药物。
