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Acne vulgaris affects most teenagers and continues to affect many patients into their twenties and their thirties. The pathophisiology of acne involves the following six steps.
- Sebum production stimulation by androgens
- Sebaceous follicle outlet obstruction by sebum and keratinous debris
- Accumulation of sebum and keratin, and formation of open and closed comedones (blackheads and whiteheads)
- Bacterial colonization by Propionibacterium acnes of the trapped sebum and keratin
- Inflammatory response to Propionibacterium acnes colonization
- Appearance of inflammatory acne papules, pustules, nodules, and cysts