Acne · 4 mechanisms + the real diet story

痤疮 · 4 大机制 + 饮食的真实作用

Place · Level 3 · Condition

皮脂 + 角质 + 痤疮丙酸杆菌 + 炎症 · 高 GI + 乳清显著加重 · 巧克力面油是迷思 · 治疗看严重度分层

Connected to · 1

regulates · 1

Zinc
Some people with acne run low on zinc, and correcting that improves inflammatory lesions — correcting it, not megadosing it long term.

4 mechanisms

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4 大机制 · 痤疮怎么形成

Acne vulgaris is chronic inflammation of the pilosebaceous unit, involving 4 interacting mechanisms (Zaenglein 2016 AAD guideline):

① Sebum hypersecretion:

Androgens (especially DHT) stimulate sebaceous glands → ↑ sebum outputSebaceous gland enlargement during puberty + androgen surge → peak acne yearsAdult-female cyclical hormone fluctuation (7-10 days premenstrual)
② Follicular hyperkeratinization:

Excess keratinization + adhesion at the follicular opening → blockage (microcomedone)This is the earliest lesion of acne and is invisible to the eye
③ Cutibacterium acnes (C. acnes, formerly P. acnes) proliferation:

Skin commensal, not an 'infection' — key insightOver-proliferates in the blocked, sebum-rich environmentReleases inflammatory mediators + neutrophil chemotaxisStrain matters: certain strains correlate with severe acne; commensal strains don't cause disease
④ Inflammatory response:

Innate immunity (TLR2) recognizes C. acnes → releases IL-1 / Inflammation precedes the comedone — not the other way aroundInflammation determines red bumps / pustules / nodules / cysts
Clinical grading:

Mild: mainly comedones (open / closed) + few papulesModerate: many papules / pustules, some inflammationSevere: nodules / cysts / prone to scarringAcne fulminans: acute onset + systemic symptoms (fever / arthralgia) — rare but needs urgent care
Differential (don't call these 'pimples'):

Rosacea: persistent erythema + telangiectasia, no comedonesSebaceous hyperplasia: centrally umbilicated yellow papules, unrelatedFolliculitis: bacterial / fungal, itchy, different distributionHormonal cystic acne lasting 6+ months unresolved → screen for PCOS / hyperandrogenism
Genetic + endocrine background:

Strong family history of severe acne is the single biggest independent risk factorPCOS / hyperandrogenism → persistent acne + hirsutism + menstrual irregularityAnabolic steroid abuse → triggers / worsens

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Educational content, not medical advice — consult a clinician.

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