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By Gerd Plewig MD, Albert M. Kligman MD, PhD (auth.)

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Extra resources for Acne: Morphogenesis and Treatment

Example text

High unphysiologic doses of estrogens reduce sebum production by about 50 to 70%, accompanied by shrinkage of the gland. No matter what the dose the gland cannot be completely ablated pharmacologically. The amount of estrogen in contraceptive pills is comparatively low, enough to cause anovulatory cycles. The" pill" decreases sebum production by about 20-40% without an appreciable diminution in gland size. Reduction of this magnitude generally results in an improvement in acne. It should be noted though that he degree to which sebum has to be suppressed by estrogen or any other modality to achieve clinical improvement has not been established.

What then are we to think of reports which claim very rapid changes in the composition or amount of sebum produced under the impact of some experimental variable? For example, sudden increases in sebum have been noted during psychiatric interviews in which stressfull topics were being deliberately discussed. In other studies, the free fatty acids were reported to have increased over a few days during student examinations, said to be a result of emotional tension. A high carbohydrate diet has been found to alter the composition of sebum in a few days, another result which must be deemed miraculous in view ofthe known kinetics.

Sebum secretion and sweating are in fact independent functions. However, sweating definitely increases the appearance of oiliness. This is a purely visual effect probably related to the coating of water droplets by a monomolecular film of oil. Sebum spreads rapidly over a wet surface. Many observers have been deceived by this phenomenon, thinking that the sudden appearance of oiliness after some sweating stimulus represented a genuine increment of sebum. This is attractive to those who see acne as a psychosomatic disease but it is unsupportable.

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