Acne Cascade

Question 1

What is the first step in the acne cascade?

Answer 1

Increased follicular keratinization, forming a microcomedone and dense plug

Question 2

What is the second step in the acne cascade?

Answer 2

Increased sebum production due to androgens; sebum becomes trapped and forms a comedo

Question 3

What is the third step in the acne cascade?

Answer 3

Bacteria proliferates (feeds off sebum)
This leads to bacterial lipolysis of sebum triglycerides to free fatty acids (forms comedone) (fatty acids increase keratinization)

Question 4

What is the last step in the acne cascade?

Answer 4

Inflammation (T-cell activity) due to increase in P. acnes, polymorphonucleocytes move to follicle, bacteria release chemokines –> pus formation