REVIEW | PUBLISHED ARTICLE
Taking a More Holistic View of the Pathogenesis of Acne
In this article, system-wide factors that may be amenable to treatment with complementary and alternative medical treatments are described.
Summary:
The development of acne is conventionally viewed as the results of four pathogenic features that occur at the pilosebaceous unit: follicular hyperkeratinization, excess sebum production, Cutibacterium acnes colonization and a local immune response.
However, emerging research shows that acne pathogenesis extends beyond these localized mechanisms to include systemic influences that can exacerbate inflammation and lesion formation. Factors such as hormonal fluctuations, stress, diet, and lifestyle behaviors interact through endocrine, metabolic, and neuroimmune pathways to affect skin health and sebum regulation. This broader understanding of acne’s origins supports a more comprehensive management approach—one that pairs traditional therapies with complementary strategies addressing whole-body drivers of inflammation, oxidative stress, and microbiome balance. This article was contributed to by Patricia K. Farris, MD, FAAD.
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