madman
Super Moderator
ABSTRACT
Previous approaches to acne management have focused on the four main factors implicated in acne, namely, androgen-mediated sebogenesis (considered integral to acne), hyperkeratinization, colonization with Cutibacterium acnes, and inflammation related to both innate and adaptive mechanisms. Recent advances have facilitated potential novel approaches to acne management, as the pathophysiology and the immunological aspects related to acne and wound healing have evolved. Particular targets that have been shown to be closely involved in acne pathophysiology and wound healing include interleukin (IL)-1b, IL-17, IL-23, and tumor necrosis factor-alpha (TNFa). Biological antibodies targeting IL-1b, IL-17, IL-23, and TNFa could provide novel approaches for treating severe acne and related disorders. Acne is primarily a disease associated with sebogenesis. Monosaturated free acids are important components. Insulin growth factor 1 (IGF-1) promotes the proliferation and differentiation of sebocytes and IL-1b. Research into the microbiome may also provide insights into potential future therapeutic options for acne. Scars, both atrophic and hypertrophic, are common sequelae to acne. Risk factors associated with the development of acne scars include genetic, systemic, local, and lifestyle factors. Pro-inflammatory cytokines have been shown to play a crucial role in the development of acne-induced hypertrophic scars. Treatment for extensive inflammatory keloid scarring is limited. Surgery and postoperative radiotherapy are two possible options. Transforming growth factor-b (TGFb), IL-6, matrix metalloproteinase (MMP), IGF-1 and B cells are found in keloid or hypertrophic scar tissues. Biological antibodies targeting these cytokines may be a potential strategy for the prevention and treatment of this type of scar in the future. Future treatment for acne should embrace approaches that target the main etiological factors of acne. In particular, a specific emphasis on aggressive treatment in the acute inflammatory phase to reduce the likelihood of scarring and other clinical sequelae, such as pigmentary changes would be highly desirable. Treatment for established acne-induced sequelae should also be considered.
INTRODUCTION
Recent advances have further elucidated the pathogenesis of acne: it is now clear that immunological factors play an important role [1]. To date, acne pathogenesis has implicated four major factors: androgen-dependent sebogenesis, hyperkeratinization of the infundibulum, Cutibacterium acnes (C. acnes) colonization, and inflammation [2]. Successful targeted therapy for acne currently includes topical retinoids that normalize abnormal hyperkeratinization in the infundibulum and novel topical retinoids with anti-inflammatory properties [3]. Topical and oral antimicrobials inhibit bacterial proliferation and reduce inflammation related to cytokines and extracellular enzymes [4]. Topical benzoyl peroxide (BPO) is highly effective in reducing both sensitive and resistant strains of C. acnes and has some impact on hyperkeratinization in the infundibulum [5, 6]. Anti-androgens can regulate androgen metabolism, resulting in suppression of sebum excretion [7]. Orally administered isotretinoin is currently the only agent that can affect all four main factors implicated in acne [2, 3].
*This review aims to clarify targets based on acne pathogenesis and summarize treatment options for acne in the future.
This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.
*HOW CAN RECENT ADVANCES IN ACNE PATHOGENESIS INFORM FUTURE TREATMENT?
*PATHOPHYSIOLOGICAL TARGETS FOR ACNE TREATMENT
Hyperkeratinization
Sebum
Wound Healing
Upregulation of Gene Expression
*UPDATED TARGETED THERAPY BASED ON ACNE PATHOGENESIS
*POTENTIAL TARGETS FOR ACNE MANAGEMENT
Targets for Inflammation
Targets for Hyperkeratinization
Targets for Sebogenesis
Targets for Wound Healing
Alternative Therapies
*FUTURE TREATMENT FOR ACNE
*Treatment for Acne
Possible Treatments for Acne Sequelae
Post-inflammatory Hyperpigmentation Vitamin C, hydroquinone, azelaic acid, tranexamic acid, chemical peeling, and iontophoresis can be used.
Hypertrophic Scar and Keloid
Topical corticosteroids injection, vitamin C, hydroquinone, azelaic acid, tranexamic acid, chemical peeling, iontophoresis, TGFb inhibitor, IL-6 Ab, IL-17 Ab, saireito (a Japanese herb), platelet-rich plasma (PRP), laser, radiation therapy, compression therapy, and mechanotherapy can be used.
CONCLUSION
In this review, we summarize updated treatments facilitating potential novel approaches in acne treatment including immunology and wound healing. In particular, biological treatments targeting IL-1b, IL-17, IL-23, and TNFa could provide novel approaches for treating severe acne and related disorders. In addition, biological antibodies targeting TGFb, IL-6, MMP, IGF-1, and B cells may be a potential strategy for the prevention and treatment of this type of scar in the future. Future treatment for acne should embrace approaches that target the main etiological factors of acne.
Previous approaches to acne management have focused on the four main factors implicated in acne, namely, androgen-mediated sebogenesis (considered integral to acne), hyperkeratinization, colonization with Cutibacterium acnes, and inflammation related to both innate and adaptive mechanisms. Recent advances have facilitated potential novel approaches to acne management, as the pathophysiology and the immunological aspects related to acne and wound healing have evolved. Particular targets that have been shown to be closely involved in acne pathophysiology and wound healing include interleukin (IL)-1b, IL-17, IL-23, and tumor necrosis factor-alpha (TNFa). Biological antibodies targeting IL-1b, IL-17, IL-23, and TNFa could provide novel approaches for treating severe acne and related disorders. Acne is primarily a disease associated with sebogenesis. Monosaturated free acids are important components. Insulin growth factor 1 (IGF-1) promotes the proliferation and differentiation of sebocytes and IL-1b. Research into the microbiome may also provide insights into potential future therapeutic options for acne. Scars, both atrophic and hypertrophic, are common sequelae to acne. Risk factors associated with the development of acne scars include genetic, systemic, local, and lifestyle factors. Pro-inflammatory cytokines have been shown to play a crucial role in the development of acne-induced hypertrophic scars. Treatment for extensive inflammatory keloid scarring is limited. Surgery and postoperative radiotherapy are two possible options. Transforming growth factor-b (TGFb), IL-6, matrix metalloproteinase (MMP), IGF-1 and B cells are found in keloid or hypertrophic scar tissues. Biological antibodies targeting these cytokines may be a potential strategy for the prevention and treatment of this type of scar in the future. Future treatment for acne should embrace approaches that target the main etiological factors of acne. In particular, a specific emphasis on aggressive treatment in the acute inflammatory phase to reduce the likelihood of scarring and other clinical sequelae, such as pigmentary changes would be highly desirable. Treatment for established acne-induced sequelae should also be considered.
INTRODUCTION
Recent advances have further elucidated the pathogenesis of acne: it is now clear that immunological factors play an important role [1]. To date, acne pathogenesis has implicated four major factors: androgen-dependent sebogenesis, hyperkeratinization of the infundibulum, Cutibacterium acnes (C. acnes) colonization, and inflammation [2]. Successful targeted therapy for acne currently includes topical retinoids that normalize abnormal hyperkeratinization in the infundibulum and novel topical retinoids with anti-inflammatory properties [3]. Topical and oral antimicrobials inhibit bacterial proliferation and reduce inflammation related to cytokines and extracellular enzymes [4]. Topical benzoyl peroxide (BPO) is highly effective in reducing both sensitive and resistant strains of C. acnes and has some impact on hyperkeratinization in the infundibulum [5, 6]. Anti-androgens can regulate androgen metabolism, resulting in suppression of sebum excretion [7]. Orally administered isotretinoin is currently the only agent that can affect all four main factors implicated in acne [2, 3].
*This review aims to clarify targets based on acne pathogenesis and summarize treatment options for acne in the future.
This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.
*HOW CAN RECENT ADVANCES IN ACNE PATHOGENESIS INFORM FUTURE TREATMENT?
*PATHOPHYSIOLOGICAL TARGETS FOR ACNE TREATMENT
Hyperkeratinization
Sebum
Wound Healing
Upregulation of Gene Expression
*UPDATED TARGETED THERAPY BASED ON ACNE PATHOGENESIS
*POTENTIAL TARGETS FOR ACNE MANAGEMENT
Targets for Inflammation
Targets for Hyperkeratinization
Targets for Sebogenesis
Targets for Wound Healing
Alternative Therapies
*FUTURE TREATMENT FOR ACNE
*Treatment for Acne
Possible Treatments for Acne Sequelae
Post-inflammatory Hyperpigmentation Vitamin C, hydroquinone, azelaic acid, tranexamic acid, chemical peeling, and iontophoresis can be used.
Hypertrophic Scar and Keloid
Topical corticosteroids injection, vitamin C, hydroquinone, azelaic acid, tranexamic acid, chemical peeling, iontophoresis, TGFb inhibitor, IL-6 Ab, IL-17 Ab, saireito (a Japanese herb), platelet-rich plasma (PRP), laser, radiation therapy, compression therapy, and mechanotherapy can be used.
CONCLUSION
In this review, we summarize updated treatments facilitating potential novel approaches in acne treatment including immunology and wound healing. In particular, biological treatments targeting IL-1b, IL-17, IL-23, and TNFa could provide novel approaches for treating severe acne and related disorders. In addition, biological antibodies targeting TGFb, IL-6, MMP, IGF-1, and B cells may be a potential strategy for the prevention and treatment of this type of scar in the future. Future treatment for acne should embrace approaches that target the main etiological factors of acne.
