Acne-Associated Syndromes

The 2019 document outlines the relationship between acne and various syndromes, emphasizing the role of inflammation and insulin resistance in acne pathogenesis. It explains how sebocytes contribute to skin inflammation, with insulin-like growth factor-1 (IGF-1) exacerbating the expression of inflammatory cytokines. Acne vulgaris is linked to insulin resistance, particularly in certain patient groups, and NLRP3 inflammasome activation is associated with increased IL-1ß secretion and insulin resistance. The document lists several acne-associated syndromes, such as autoinflammatory syndromes with inflammasome mutations, syndromes with androgen excess and/or insulin resistance like congenital adrenal hyperplasia, SAHA syndrome, polycystic ovary syndrome, and HAIR-AN syndrome. It also discusses acne fulminans, an acute autoinflammatory condition with systemic symptoms, and its treatment with prednisone and isotretinoin. SAPHO syndrome, characterized by skin and osteoarthropathy, is treated with NSAIDs, corticosteroids, DMARDs, and biologicals targeting IL-1ß and TNFα. The prognosis for acne fulminans is generally good with treatment, while SAPHO syndrome requires a variable treatment approach. Non-classical adrenal hyperplasia is treated with oral glucocorticoids, and SAHA syndrome is debated as a distinct entity or a term for states of androgen excess. PCOS, affecting 5-10% of women of childbearing age, is associated with obesity and diabetes, with 23-35% of patients experiencing acne, and is treated with weight reduction, insulin sensitizers, and oral contraceptives. HAIR-AN syndrome is treated similarly to PCOS. Acne fulminans requires immediate treatment with systemic steroids, antibiotics, and analgesics, and may overlap with SAPHO syndrome.