Analysis of the water soluble extract of comedones

Pro-inflammatory levels of interleukin-1 alpha-like bioactivity are present in the majority of open comedones in acne vulgaris

The factors that initiate the inflammatory response in acne are not known. The presence of pro-inflammatory cytokines in acne comedones was therefore investigated. One hundred eight open comedones were collected from 18 untreated acne patients (10 male, 8 female). Each comedone was homogenized and centrifuged, and the supernatant was analyzed for bioactive and immunochemically detectable IL-1 alpha, IL-1 beta, and TNF alpha. Viable counts of propionibacteria, staphylococci, and Malassezia spp. were determined in the comedone pellet. Bioactive IL-1 alpha-like material was demonstrated in 76% of open comedones (range of 23-4765 pg IL-1 alpha-like bioactivity/mg of comedone material). In 58% of comedones, levels exceeded 100 pg/mg. There was no correlation between IL-1 alpha-like bioactivity and IL-1 alpha determined immunochemically. Bioactive IL-1 beta was not detected in any comedones. Twenty-four percent contained low levels of immunochemical IL-1 beta (range 12-103 pg IL-1 beta/mg comedone material). Bioactive TNF alpha was detected in three comedones with a further five comedones containing immunochemical TNF alpha (range of 61-820 pg TNF alpha/mg comedone material). The majority of open comedones (97%) contained microorganisms. There was, however, no significant correlation (Spearman's rank) between levels of any cytokine, in particular IL-1 alpha-like bioactivity, and numbers of microorganisms. Thus, bioactive IL-1 alpha-like material in the majority of open comedones may be concerned in the initiation of inflammation in acne following spongiosis or rupture of the pilosebaceous follicle wall.

Leukocyte chemotactic properties of soluble horny contents in epidermal cysts

Epidermal cysts are one of the most common tumors of the skin. Although asymptomatic ordinarily, they may sometimes become severely inflamed with massive invasion of polymorphonuclear leukocytes (PMN). We studied in vitro PMN chemotactic properties of the aqueous extract prepared from the horny material of epidermal cysts obtained from three patients. A crude aqueous extract of the horny content of the cysts showed PMN chemotactic activity, which, however, was less than that of a horny layer extract prepared from normal skin. Characterization of PMN chemotactic activity using a Sephadex G-75 column showed a peak in the low molecular weight fractions eluting between the vitamin B12 and phenol red markers, which corresponds with the peak of absorbance at 280 nm. The chemotactic substances withstood boiling and trypsin or protease digestion. Although the chemotactic activity was partially ether-extractable, the presence of leukotriene B4 was not demonstrated by radioimmunoassay. In addition to their own chemotactic activity, the horny extracts of epidermal cysts showed cytotaxigenic properties in the presence of fresh serum.

Antibodies to P. acnes and P. acnes exocellular enzymes in the normal population at various ages and in patients with acne vulgaris

Total serum IgM and IgG agglutinins to P. acnes and neutralizing antibodies to P. acnes lipase, hyaluronate lyase and acid phosphatase were measured in normal individuals of different age groups. Agglutinins to P. acnes were detected in infants at 4 months of age and were present at a high level throughout life. A switch from predominantly IgM agglutinins in children, to IgG agglutinins in adults, occurred during adolescence. Anti-P. acnes lipase antibodies were present in 20% of teenagers and 17-42% of adults. Anti-P. acnes hyaluronate lyase antibodies were found in adults only (4-17%). Antibodies to acid phosphatase were not detected. Agglutinins to P. acnes were measured in individuals with mild, moderate and severe acne, and in normal controls. Only patients with severe acne had significantly higher titres than the controls. IgM and IgG agglutinins were determined in 13-14-year-olds with mild, moderate and severe acne, and in normal controls. Thirty-three per cent, 60% and 100% of the acne patients, respectively, but none of the normal controls, had predominantly IgG agglutinins. No difference in the prevalence or titre of antibodies to P. acnes exocellular enzymes was observed when patients with severe acne were compared with normal controls. There was no evidence to suggest a role for antibodies to P. acnes exocellular enzymes in the initiation of inflammatory acne.

Anti-P. acnes antibody in comedonal extracts

Extracts of comedonal material obtained from patients with acne vulgaris were analyzed for albumin, IgG, IgM, IgA, and anti-Propionibacterium acnes antibodies using immunodiffusion and anti-immunoglobulin hemagglutination tests. Extracts were obtained from comedones of patients with (1) comedonal, (2) papulopustular, (3) nodular-cystic, (4) "burned out" acne, (5) patients under oral tetracycline treatment, and (6) with pustules. In all comedonal extracts analyzed, albumin and IgG (ratio approximately 1:2.5) could be detected. IgM, IgA, and C3 could not be found in noninflamed comedones by the techniques used; pustules, however, contained all immunoglobulin classes and albumin in ratios found in serum as well as C3. The anti-P. acnes antibody activity in the comedonal extracts was associated with the IgG class. Immunofluorescence microscopical examination of material from single comedones obtained by the cyano-acrylate technique showed IgG antibody on rod-shaped bacteria. The amount of IgG and albumin in comedonal extracts from the various patient groups was not different. It is concluded that IgG (and antibody of the IgG class) in comedones is derived from the serum and selectively accumulated in the follicle by an unknown mechanism.

A method for the assay of inflammatory mediators in follicular casts

A method is presented whereby inflammatory mediators may be detected and quantified in individual follicular casts. Lysozyme, lactoferrin, IgG, IgM, C3 and material reacting with antiserum to polymorphonuclear leukocytes (PMN) were assayed by functional and immunologic methods. By these techniques, lysozyme, IgG and anti-PMN reactive material were detected in clinically uninflamed follicular casts from acne subjects.