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SOME NEW CONSIDERATIONS ABOUT THE CHEMISTRY OF ACNE VULGARIS By THELMA GOLUB WARSHAW, M.D. Presented at the May loth, 1957, Meeting of the Society of Cosinetic Chemists, New York City. TaE FO•.•.OW•NG discussion about the pathologic mechanism causing acne vulgaris is offered in all humility, on the basis of. medical practice, clinical research and arm-chair philosophy. The theory to be presented is, to this observer, the most plausible key to the pathogenesis of acne vulgaris, and is the simplest explanation for all the known facts about the condition. The prevailing dermatological thought about acne vulgaris is that it is a sebaceous gland dysfunction of the adolescent years, predicated upon an androgen plus progesterone/estrogen imbalance. Androgen is male sex hormone, estrogen and progesterone are female sex hormones. It is considered that androgens tend to predominate, and that the adrenal cortices are ii• some way involved. Secondary infection of the basic acne lesionq the blackhead or comedone--produces the pustules of ache. At this point it is necessary to realise that repeatedly observed clinical and laboratory data about acne are factual but some serious illogic is involved in the current explanatory theory of androgen/estrogen imbalance. 1. It is a fallacy to assume that, because events coincide chronologically, they are causally related. For example, the epiphyses of the long bones fuse during puberty, but that does not mean that epiphyseal union is a cause of the acne of adolescence. In like fashion, it is very questionable that, because androgens and estrogens come into play during adolescence, they therefore must cause acne. 2. It is erroneous to assume that factors that have an influence upon a situation must necessarily cause that situation. For example, bacterial infection can cause pustular lesions in acne, but that does not mean that bacterial infection causes acne. In like fashion, the androgens, progesterones, and estrogens that come into play during the teen years persist throughout a great part of mature life, when acne vulgaris is not generally present. These hormones influence the course of ache, but do not produce acne. A study on the urinary excretion of 17 ketosteroids (a neutral hormone that represents androgen and adrenal cortical activity) showed no difference in values between acne and non-acne patients. In the same study, the 17 KS/estrogen ratios were the same in normal persons as in acne patients. • It has been observed that administration of the androgen, testosterone, can produce an acneform eruption however, even in boys 50 to 70 per cent of the body steroid output (that is measured by 17 KS excretion) comes 252