![]() ![]() 17Īnother hallmark of sebum in acne patients is the presence of lipoperoxides, mainly due to the peroxidation of squalene and a decrease in the level of vitamin E, the major sebum antioxidant. 16 Typical western diet, comprised of milk and hyperglycaemic foods, may have potentiating effects on serum insulin and insulin-like growth factor-I (IGF-I) levels, thereby promoting the development of acne. 14, 15 Other studies have demonstrated that increased consumption of dietary fat or carbohydrate increases sebum production and modifications to the type of carbohydrate can also alter sebum composition. On the other hand, extreme caloric restriction dramatically decreases the sebum excretion rate and these changes can be reversed when a normal diet is resumed. It has recently been hypothesised that low glycemic load diet may influence sebum production based on the beneficial endocrine effects of its components. ![]() 12 This notion is supported also by the observation that sebum contains linoleic acid, an essential fatty acid that cannot be synthesised in vivo and therefore must be obtained from the diet. 11 Evidence suggests that diet may be an important source of substrate for the synthesis of sebaceous lipids. 10 Moreover, low levels of linoleic acid have been observed in skin surface lipids of acne patients. Lower essential fatty acid levels were found in wax esters in twins with acne rather than in twins with no acne. 9 The composition of the produced lipids is also of great importance. However, seborrhoea per se is not considered to be the only responsible factor for the development of acne, as demonstrated by the success of treatment with agents with no effect on sebum secretion rate that can inhibit the inflammatory process, such as antibiotics, topical retinoids, azelaic acid and benzoyl peroxide. 5 If sebum interferes with the process of follicular keratinisation in the pilosebaceous unit, pore blockage may occur, contributing to lesion formation and acne. Increased sebum excretion, alteration of lipid composition and the oxidant/antioxidant ratio characteristic of the skin surface lipids are major concurrent events associated with the development of acne.
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