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Getting acne....Q&A............(part 3 of 5)

I’ve started getting acne spots. How long do they last? This depends on what type of spots they are and, even then, it can be very difficult to predict what will happen. Some spots will appear and then disappear during the course of a day but others will evolve more gradually through the various stages. Comedones can be very persistent if they don’t get inflamed. Mildly inflamed spots will last 5–10 days before settling down, but can leave a flat red mark (macule) for several weeks. Nodules and cysts may last for weeks or months unless you get some treatment. What is the difference between a whitehead and a yellow- head spot? These two common terms describe quite different types of spot. A whitehead is a closed comedone where the pore is blocked and not open to the air. There is no inflammation (redness). A yellow- head suggests a spot with pus in it. The medical term is a ‘pustule’. Whiteheads may become yellowheads if the blocked pore becomes infected. My daughter is only 9 but she seems
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THE ROLE OF PROPIONIBACTERIUM ACNES–SPECIFIC IMMUNITY IN ACNE

The presence of elevated immunity to P. acnes may be the factor that determines
the severity of a patient’s acne. Other potential explanations such as elevated
androgens and subsequent increased sebum secretion clearly may play a role in
determining acne severity, but their influence is probably not the primary issue.
It is known that virilized women may have more severe acne (44), but not all
hyperandrogenic women fit this stereotype. In fact, many hirsuite, hyperandrogenic
women have no acne at all, and among those who do have acne, it tends not to be
particularly severe (45,46). Moreover, correction of the hyperandrogenicity typically
results in an improvement, but not a complete resolution of the acne (47). Thus,
virilization is permissive for severe acne, but not the prime factor that causes it.
There is substantial evidence that a patient’s anti-P. acnes immunity may
be the factor that determines acne severity. Agglutinating and complement-fixing
antibodies to P. acnes are elevated in proportion to the severity of acne inflammation
(48–51). Lymphocyte proliferation in response to P. acnes antigens is likewise elev-
ated (52,53). Skin test reactivity to comedonal contents and to P. acnes fractions is
proportional to acne severity as well (54).
There is substantial evidence that elevated immunity makes P. acnes a more
potent inflammatory stimulus. Complement activation by comedonal contents is
increased by the addition of anti-P. acnes antibody (31). Complement activation
by P. acnes organisms in vitro is intensified by increasing amounts of anti-P. acnes
antibody (33) and results in the generation of increased amounts of neutrophil
chemoattractants. When neutrophils encounter the organism, they release destruc-
tive hydrolases into tissue in proportion to the amount of anti-P. acnes antibody
present in the system (55). Thus, humoral immunity to the organism is proinflam-
matory, rather than protective of infection, and most likely serves to intensify
inflammation and tissue damage. Which then comes first, immunity or acne? In
the absence of direct experimental data, the author would contend that the hyper-
sensitivity to P. acnes is an inherited tendency and is the factor that accounts for
many cases of severe acne in unfortunate families.
What is the future of acne research? Much is left to be understood regarding
the role of endogenous antimicrobial peptides and TLRs in controlling the inflam-
matory response in acne, and methods to decrease severe scarring are lacking.
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