INTRODUCTIONThe skin is one of the largest organs of the human body. It is a highly specializedtissue that acts as a barrier against the influences of the environment. It plays acrucial role in the protection against dehydration and the control of body tempera-ture (1). The skin’s primary role is to protect our health, but the skin’s barrier isimperfect and it also has the ability to absorb external substances. Moreover,these external substances can access healthy skin via its pilosebaceous glands.Drugs have been detected in the blood stream after topical application, demonstrat-ing transdermal delivery through the skin (2). This is desired for the treatment ofmany skin diseases, but this characteristic can also be a contributing factor forcausing many diverse health risks.The lipid environment of the stratum corneum is an essential factor for main-taining the skin’s equilibrium. Changes in the barrier lipid composition have beendirectly linked to skin barrier function impairments, such as pathologically dry andrough skin (3,4). Besides protective tasks, the skin is confronted with a tremendouschallenge during puberty, when the increase in circulating levels of testosteroneinfluences the function of pilosebaceous units (PSU) and increases sebogenesis.Increased sebum levels are a major contributory factor in acnegenesis. Duringpuberty, the pituitary gland initiates the sexual maturation process via the release
of gonadotropins and the production of hormones called androgens. This process
regulates the production of sebum in the sebaceous glands of both adolescent
boys and girls (5). This is the time period in which most adolescents develop a
more or less severe form of acne. Although superficial and non-life-threatening,
acne is a disease that, if left untreated, can have serious physical and psychological
consequences (6,7).
Acne is one of the most common skin diseases of human kind, affecting 80%
of adolescent boys and girls during puberty (8) that may persist throughout adult-
hood, or it may even develop after puberty (commonly known as persistent or late
onset acne, respectively) (9). Sebum hypersecretion is the first problem associated
with acne-prone skin and is caused by the enzymatic hyperactivity of 5-alpha-
reductase—a key enzyme that converts testosterone into dihydrotestosterone
(DHT) (5). By binding to its receptor in the skin, DHT stimulates the secretion
of sebum (Fig. 1). Men are more severely affected because they produce higher
concentrations of androgens that regulate sebum production and enlargement of
sebaceous glands (10,11).
The earliest morphological change observed in acne patients is the aberrant
follicular epithelial proliferation and differentiation of the PSU that results in clini-
cally invisible microcomedones (12–15). Due to the hormonal imbalance in
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