الفهرس 
Biology of Sebaceous GlandsOnly 14 pages are availabe for public view
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Abstract
Human sebaceous glands are found over the entire skin surface (except the palms and soles), but sebum secretion is highest on the scalp, face, chest, and back. The most obvious function of the sebaceous gland is to secrete sebum.
Sebaceous gland functions, which are possibly involved in the development of acne are production of sebum, regulation of cutaneous steroidogenesis, regulation of local androgen synthesis, interaction with neuropeptides, synthesis of specific lipids with antimicrobial activity and exhibition of pro- and anti-inflammatory properties.
Sebum production is continuous and is not controlled by neural mechanisms. Retinoids, hormones and growth factors influence sebaceous gland growth and differentiation. Androgens and growth hormone promote the differentiation of sebaceous glands whereas estrogens and retinoids such as 13-cis retinoic acid inhibit their differentiation.
Acne is a chronic inflammatory disease of the pilosebaceous units. It is characterized by seborrhoea, the formation of comedones, erythematous papules and pustules, less frequently by nodules, deep pustules, or pseudocysts and in some cases, is accompanied by scarring.
The most notable pathophysiologic factors that influence the development of acne are altered follicular growth and differentiation, sebaceous gland hyperplasia with seborrhea, P. acnes colonization of the follicle and inflammation.
Assessment of the severity of acne vulgaris continues to be a challenge for dermatologists. No grading system has universally accepted. We used global acne grading system (GAGS) in the present study.
The relationship between blood lipids (cholesterol, triglycerides, lipoproteins) and acne have not been widely reported. Akawi et al. (2007) showed that there is a trend for plasma HDL-C of acne patients to decrease as the severity of acne condition increases. They also reported that triglycerides and LDL-C levels in severe acne cases are shown to be significantly elevated compared with those in healthy controls. Arora et al. (2010) reported that total cholesterol, LDL-C, testosterone, and progesterone levels were higher, while estrogen and HDL-C levels were decreased in severe acne patients compared to healthy controls. They also reported a positive correlation between testosterone and total cholesterol and LDL-C and a positive correlation between estrogen and triglyceride and HDL-C. We believe that these abnormalities need to be further investigated in different grades of acne and must be considered in the pathogenesis of the disease to be taken into account for the treatment of patients with acne.
The aim of this study was to evaluate serum lipids and sex hormones in female patients with different grades of acne in relation to age-matched healthy controls and to correlate serum lipid levels with sex hormonal levels in order to elucidate the effect of sex hormones on lipid profile in female patients with acne.
This study was carried out on 80 female patients with acne vulgaris. They were divided into 4 groups according to GAGS:
Group 1 (Mild acne): included 20 female patients with mild acne.
Group 2 (Moderate acne): included 20 female patients with moderate acne.
Group 3 (Severe acne): included 20 female patients with severe acne.
Group 4 (Very severe acne): included 20 female patients with very severe acne.
Twenty (20) age and sex matched healthy volunteers were included as controls. All subjects, including patients and controls, were randomly recruited and subjected to detailed history, careful general examination, dermatological examination including grading of acne into 4 groups by GAGS and determination of serum lipids and sex hormones.
The comparison between patients and controls regarding all assessed serum lipids revealed a significant decrease of HDL-C and increase of LDL-C in acne patients on comparing them with the controls.
On the other hand, the comparison between the different groups regarding all assessed serum lipids revealed a significant increase of serum cholesterol in severe acne group in comparison with moderate acne groups. There was also a significant decrease of serum HDL-C in mild, moderate and severe acne groups on comparing them with the groups of very severe acne and the controls. Additionally, there was a significant increase of serum LDL-C in mild, moderate and severe acne groups in comparison with the very severe acne group. There was also a significant increase of LDL-C in moderate acne group in comparison with the severe acne group. Finally, there was a significant increase of LDL-C in mild and severe acne groups in comparison with the controls.
The comparison between patients and controls regarding all assessed sex hormones revealed a significant increase of free testosterone and decrease of DHEA-S in acne patients on comparing them with the controls.
On the other hand, the comparison between the different groups regarding all assessed sex hormones revealed a significant increase of free testosterone in severe and very severe acne groups in comparison with the controls. There was also a significant decrease of DHEA-S in moderate, severe and very severe acne groups in comparison with the controls.
The correlation between sex hormones and serum lipids in female acne patients revealead a significant positive correlation between free testosterone and LDL-C. There was also a significant positive correlation between DHEA-S and HDL-C in female acne patients.
Because the results of all available studies are controversial, the complex relationship of acne, sex hormones and serum lipids should be considered in each patient, because solid hard facts are not documented.
Further studies on large number of patients are recommended to assess the relation between serum lipids and sex hormones in different grades of acne.