Downing D T, Stewart M E, Wertz P W, Strauss J S
J Am Acad Dermatol. 1986 Feb;14(2 Pt 1):221-5. doi: 10.1016/s0190-9622(86)70025-x.
Acne is characterized by hyperkeratosis of the follicular epithelium, leading to horny impactions that may lie dormant as open or closed comedones or may cause inflammation of the follicle. Although persons with acne have consistently been observed to have elevated levels of sebum secretion, no mechanism relating sebum secretion rates to comedogenesis is known. Acne patients have also been shown to have low levels of linoleic acid in their skin surface lipids. To explain this observation, the hypothesis is advanced that the linoleate concentration in human sebum depends on the quantity of linoleic acid present in each sebaceous cell at the commencement of its differentiation and on the extent to which this initial charge is diluted by subsequent endogenous lipid synthesis in each sebaceous cell. A corollary hypothesis holds that low concentrations of linoleate in sebum impose a state of essential fatty acid deficiency on the cells of the follicular epithelium and induce the characteristic response of hyperkeratosis. Both hypotheses could hold, without there being a systemic deficiency of linoleic acid, simply as the result of elevated lipogenesis in individual sebaceous cells.
痤疮的特征是毛囊上皮过度角化，导致角质栓形成，这些角质栓可能以开放性或闭合性粉刺的形式潜伏，也可能引起毛囊炎症。尽管一直观察到痤疮患者的皮脂分泌水平升高，但尚无将皮脂分泌率与粉刺形成相关联的机制。痤疮患者皮肤表面脂质中的亚油酸水平也较低。为了解释这一现象，有人提出假说，即人皮脂中亚油酸的浓度取决于每个皮脂腺细胞在分化开始时所含亚油酸的量，以及该初始含量在每个皮脂腺细胞中被随后的内源性脂质合成稀释的程度。一个相关假说认为，皮脂中亚油酸浓度低会使毛囊上皮细胞处于必需脂肪酸缺乏状态，并诱导特征性的过度角化反应。这两个假说都有可能成立，而无需亚油酸存在全身性缺乏，这仅仅是单个皮脂腺细胞中脂肪生成增加的结果。
