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    Inflammation crucial to acne lesions, dermatologic syndromes

    Gerd Plewig, M.D., F.R.C.P., professor emeritus of the department of dermatology, University of Munich, Munich, Germany.New conventional wisdom of late identifies inflammation as an important link between the development of acne lesions and several dermatologic syndromes including PAPA (pyogenic arthritis, pyoderma gangrenosum, acne), PASH (pyoderma gangrenosum, acne, suppurative hidradenitis), PAPASH (pyogenic arthritis, pyoderma gangrenosum, acne, suppurative hidradenitis), and SAPHO (synovitis, acne, pustulosis palmoplantaris, hyperostosis, osteitis). Therefore, it is increasingly believed that therapies targeting the inflammation could be useful in quelling the clinical symptoms of these diseases and conditions, offering much needed hope for this patient population. 

    READ: Acne pathogenesis

    The pathogenesis of acne lesions has traditionally been associated with the colonization of Propionibacterium acnes in the sebaceous follicles, which leads to an innate immune response and progression of so-called non-inflammatory comedones to inflammatory papules, pustules and nodules. It is now widely thought that this inflammation is not only present at all stages of acne lesion development, but is one of the central common denominators found in PAPA, PASH, PAPASH, and SAPHO syndromes.

    SEE: Before and after pictures

    According to one expert, these new associations must be better recognized by clinicians in order to help exact a definitive and timely diagnosis of these syndromes and further, to implement appropriate therapy in affected patients.

    READ: Gold microparticles zap sebaceous follicles

    “Although these syndromes are considered to be rare, they are not as rare as one may initially suppose, as most of the patients we see or have seen were misdiagnosed. Therefore, dermatologists need to better recognize these syndromes and the associations among these conditions and diseases to optimally treat their patients,” said Gerd Plewig, M.D., F.R.C.P., professor emeritus of the department of dermatology, University of Munich, Munich, Germany.

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