title: Inflammatory events are involved in acne lesion initiation.
abstract: The earliest subclinical acne "lesion" is a microcomedone, of which hyperproliferation of the follicular epithelium is a characteristic feature. Inflammatory cells have been observed at the periphery of these "lesions". This study investigated whether inflammatory events occur pre or post hyperproliferative changes. Cellular, vascular, and proliferative markers were examined by immunohistochemical techniques on biopsies of clinically normal follicles from uninvolved skin and early inflamed lesions from acne patients. Control follicles were obtained from non-acne subjects. Follicles from uninvolved skin exhibited no microcomedonal features. Proliferation in the epithelium was comparable to controls and was significantly lower than in inflamed lesions. Numbers of CD3+, CD4+ T cells were elevated in the perifollicular and papillary dermis although levels were not equivalent to those in papules. The number of macrophages was also greatly increased and similar to those in papules. There were no changes in blood vessel numbers or vascular intercellular adhesion molecule 1 expression but E-selectin expression was increased to levels found in papules and vascular adhesion molecule 1 levels were upregulated. Levels of the pro-inflammatory cytokine interleukin-1 were also upregulated perifollicularly. Moreover, aberrant integrin expression was demonstrated in the epidermis around these uninvolved follicles and inflamed lesions whereas the basement membrane was still intact. These results provide novel evidence for vascular endothelial cell activation and involvement of inflammatory responses in the very earliest stages of acne lesion development.
authors.affiliation: University of Leeds, and Leeds General Infirmary, Leeds, UK.
authors.forename: Anthony H T
authors.initials: AH
authors.lastname: Jeremy
authors.forename: Diana B
authors.initials: DB
authors.lastname: Holland
authors.forename: Susan G
authors.initials: SG
authors.lastname: Roberts
authors.forename: Kathryn F
authors.initials: KF
authors.lastname: Thomson
authors.forename: William J
authors.initials: WJ
authors.lastname: Cunliffe
mesh_terms: D000152:Acne Vulgaris / Q000276:immunology* / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D015703:Antigens, CD / Q000032:analysis; D018949:Antigens, CD1 / Q000032:analysis; D015214:Antigens, Differentiation, Myelomonocytic / Q000032:analysis; D015415:Biomarkers; D001808:Blood Vessels / Q000737:chemistry / Q000166:cytology; D017252:CD3 Complex / Q000032:analysis; D015496:CD4-Positive T-Lymphocytes / Q000737:chemistry / Q000166:cytology / Q000276:immunology; D018414:CD8-Positive T-Lymphocytes / Q000737:chemistry / Q000166:cytology / Q000276:immunology; D002454:Cell Differentiation / Q000276:immunology; D002455:Cell Division / Q000276:immunology; D024141:Collagen Type IV / Q000032:analysis; D006684:HLA-DR Antigens / Q000032:analysis; D018859:Hair Follicle / Q000737:chemistry / Q000276:immunology* / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D007156:Immunologic Memory; D039503:Integrin alpha6 / Q000032:analysis; D007375:Interleukin-1 / Q000032:analysis; D015603:Keratinocytes / Q000276:immunology / Q000473:pathology; D007797:Laminin / Q000032:analysis; D007801:Langerhans Cells / Q000737:chemistry / Q000166:cytology / Q000276:immunology; D017493:Leukocyte Common Antigens / Q000032:analysis; D008264:Macrophages / Q000737:chemistry / Q000166:cytology / Q000276:immunology; D009504:Neutrophils / Q000166:cytology / Q000276:immunology; D017472:Receptors, Interleukin-1 / Q000032:analysis; D053574:Receptors, Interleukin-1 Type II; D000097382:CD68 Molecule
chemical_list: D015703:Antigens, CD; D018949:Antigens, CD1; D015214:Antigens, Differentiation, Myelomonocytic; D015415:Biomarkers; D017252:CD3 Complex; D024141:Collagen Type IV; D006684:HLA-DR Antigens; D039503:Integrin alpha6; D007375:Interleukin-1; D007797:Laminin; D017493:Leukocyte Common Antigens; D017472:Receptors, Interleukin-1; D053574:Receptors, Interleukin-1 Type II; C419393:CD1a antigen; C067980:CD68 antigen, human; D000097382:CD68 Molecule