How does the composition of sebum contribute to the formation of acne?

The major constituent of sebaceous lipid is triglyceride, which makes up over 50% of the lipid; wax esters account for 25%, squalene 15%, and there are small amounts of cholesterol esters and free cholesterol. Increased sebum production is characteristic of patients with acne, but the seborrhea itself is not sufficient to produce acne. Desaturation of the fatty acids in sebum may lead to the development of acne lesions. Lipoperoxidases characterize the sebum of acne patients, and this, along with other qualitative changes in the sebum lipids, induce alteration of keratinocyte differentiation and induce interleukin-1 (IL-1) secretion, leading to follicular hyperkeratinization.

Kurokawa I, Danby FW, Ju Q, et al: New developments in our understanding of acne pathogenesis and treatment, Exp Dermatol 18:821– 832, 2009.

Downing DT, Stewart ME, Wertz PW, et al: Essential fatty acids and acne, J Am Acad Dermatol 14:221–225, 1986.