Acne Vulgaris Clinical Trial
Official title:
Polymorphism of Extrapituitary Promoter of PRL Gene and Relationships With Serum Prolactin Levels in Acne Vulgaris.
Acne vulgaris is one of the most common skin diseases. It is a disease of the pilosebaceous units, clinically characterized by seborrhea, comedones, papules, pustules, nodules and, in some cases, scarring.
The pathogenesis of acne has been attributed to multiple factors such as increased sebum
production, alteration of the quality of sebum lipids, regulation of cutaneous
steroidogenesis, androgen activity, interaction with neuropeptides, exhibition of pro- and
anti- inflammatory properties, follicular hyperkeratinization and the action of
Propionibacterium acnes (P. acnes) within the follicle .
Central or peripheral stress may induce the development of clinical inflammation in the
pilosebaceous unit, leading to the development of acne lesions or to exacerbation of
pre-existing acne . Prolactin is one of the major hormonal signals that are immediately
upregulated on psychoemotional and physical stress .
The discovery of locally produced extrapituitary prolactin and that human skin is both a
source and target of prolactin production has increased interest in cutaneous prolactin
research . Prolactin and prolactin receptors expression have now been demonstrated in
several cutaneous cell populations, including keratinocytes, fibroblasts, sweat glands and
sebaceous glands. Hence, prolactin is likely to be involved as a mediator in the
''brain-skin axis'' .
Given that the mammary gland is an epidermal derivative, it is not surprising that the
pilosebaceous unit, another epidermal derivative, has also surfaced as a prominent,
non-classical prolactin target organ expressing prolactin receptors .
In human skin, Prolactin and prolactin receptors are both expressed in the sebaceous gland ,
and prolactin stimulates sebum production . These effects are evident in women with
hyperprolactinemia, who develop hirsutism and seborrhea, not uncommonly associated with
female pattern balding . Patients treated with hyperprolactinemia-inducing neuroleptic
agents also develop seborrhea . As sebocytes are prominent target cells of neuroendocrine
signaling , prolactin might also contribute to the aggravating effect of psychoemotional
stress on acne vulgaris. Besides the stimulation of sebocyte proliferation, which enhances
holocrine secretion of this gland, this might also be related to effects on peripheral
androgen metabolism .
The secretion of extrapituitary prolactin is regulated by the alternative promoter of
prolactin gene , and the G/T polymorphism in position -1149 seems to be associated with
level of prolactin expression .
In view of the recognized increase of human prolactin serum levels upon psychoemotional
stress and the exacerbating effect of psychological stress on acne, together with a proposed
role of prolactin in acne pathogenesis, it would be interesting to investigate the role of
prolactin in acne vulgaris
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