Acne Is a Sebum Flux Problem

01The evidence

• The primary role of sebum in the pathophysiology of acne vulgaris has been reviewed together with its therapeutic relevance, placing sebum production upstream of colonisation and inflammation.Journal of Dermatological Treatment

02The tension

Acne is framed as a bacterial disease, and antibiotics are the mainstay. Resistance is rising, and the response to antibiotics is often faster than the change in bacterial load would predict, which suggests the drug is acting on something other than the bacterium.

03The theory

Sebaceous glands deliver sebum into a narrow follicle. When production is high, the follicle becomes relatively hypoxic and the sebum composition shifts, which creates the environment in which colonisation and inflammation occur.

If flux is upstream, then the bacterium is a consequence rather than a cause. That predicts that sebum suppression should work regardless of bacterial strain, and that antibiotics should work partly through anti-inflammatory action rather than through killing.

The prediction is that sebum production rate should predict disease severity better than bacterial load, and that interventions lowering flux should outperform antibiotics in the long run while resistance rises.

The practical consequence is that sebum measurement should guide treatment, and that antibiotic courses should be short and adjunctive rather than the foundation.

04What this is not

05Predictions

• P1Sebum production rate should predict severity better than bacterial load.
• P2Sebum suppression should work across strains.
• P3Antibiotic response should exceed what the bacterial change explains.

06What would refute it

Severity tracking bacterial load at controlled sebum flux would restore the bacterial account.

07What it would change

It would make sebum the target and shorten antibiotic courses.