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Acne Biomarkers – Meaning and Clinical Use

Acne biomarkers are measurable biological parameters involved in the development, diagnosis, and monitoring of acne. They help objectively assess the severity of the condition.

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Things worth knowing about "Acne biomarkers"

Acne biomarkers are measurable biological parameters involved in the development, diagnosis, and monitoring of acne. They help objectively assess the severity of the condition.

What Are Acne Biomarkers?

Acne biomarkers are biologically measurable indicators – such as molecules, hormones, enzymes, or cells – that are associated with the development and progression of acne vulgaris. They can be detected in blood, skin, sebum, or tissue samples and provide valuable information about the underlying mechanisms of the condition as well as its severity.

Causes and Pathogenesis of Acne

Acne vulgaris is a chronic inflammatory disease of the sebaceous follicles. The key contributing factors include:

Increased sebum production (seborrhoea): Stimulated by androgens such as testosterone and DHT (dihydrotestosterone)
Follicular hyperkeratosis: Excessive keratinisation of hair follicles leads to clogged pores
Colonisation by Cutibacterium acnes: This bacterium triggers inflammatory responses in the follicle
Inflammatory processes: Immune system activation with release of cytokines and other inflammatory mediators
Insulin resistance and metabolic factors: These influence sebum production and inflammatory responses

Key Acne Biomarkers

Hormonal Biomarkers

Androgens play a central role in regulating the sebaceous glands. Relevant hormonal biomarkers include:

Testosterone and dihydrotestosterone (DHT): Elevated levels stimulate sebum production
DHEA-S (dehydroepiandrosterone sulphate): A precursor molecule of androgens, often elevated in acne patients
IGF-1 (insulin-like growth factor 1): Promotes sebum production and follicular hyperkeratosis; elevated levels are associated with more severe acne
Insulin: Chronically elevated insulin levels (e.g., from a high-sugar diet) stimulate IGF-1 and androgen activity

Inflammatory Biomarkers

Inflammatory processes are central to the formation of acne lesions. Relevant markers include:

Interleukin-1α (IL-1α): One of the earliest inflammatory signals in the follicular wall
Tumour necrosis factor-α (TNF-α): Promotes inflammatory acne lesions
Interleukin-8 (IL-8): Attracts neutrophil granulocytes and amplifies the inflammatory response
Matrix metalloproteinases (MMPs): Enzymes that degrade connective tissue and can contribute to acne scarring
Sebum lipid profile: Alterations in the fatty acid composition of sebum, particularly reduced linoleic acid levels, are indicative of active acne

Microbiological Biomarkers

The skin microbiome plays a decisive role in the development of acne:

Cutibacterium acnes (formerly Propionibacterium acnes): Elevated bacterial load or specific phylotypes (particularly type IA) are associated with acne
Microbiome diversity: Reduced diversity of the skin microbiome can indicate acne-related dysbiosis

Genetic and Epigenetic Biomarkers

Recent research is investigating genetic factors that influence susceptibility to acne:

mTORC1 activity: Overactivation of this signalling pathway is linked to increased sebum production and acne
FoxO1 transcription factor: Reduced activity of FoxO1 promotes acne development
MicroRNAs: Specific miRNA profiles in the skin can serve as biomarkers for acne severity

Diagnosis and Clinical Application

Acne biomarkers are used in clinical practice and research to:

Objectively assess and classify the severity of acne
Personalise treatment approaches (e.g., anti-androgen therapy for hormonally driven acne)
Monitor treatment success (e.g., reduction in IGF-1 levels during isotretinoin therapy)
Detect relapses at an early stage
Support the development of new treatment strategies and clinical trials

Depending on the biomarker, measurement is performed through blood tests, skin biopsies, sebum analyses, or molecular biology tests.

Relevance for Treatment

Understanding acne biomarkers opens up new therapeutic possibilities:

Retinoids (e.g., isotretinoin): Lower IGF-1 and mTORC1 activity, reduce sebum production
Antibiotics and benzoyl peroxide: Reduce the burden of Cutibacterium acnes
Anti-androgens (e.g., spironolactone): Block androgen receptors and reduce sebum production
Dietary measures: A low-glycaemic diet can lower IGF-1 and insulin levels

References

Zouboulis CC et al. – Frontiers in Sebaceous Gland Biology and Pathology. Experimental Dermatology, 2020.
Melnik BC – Linking diet to acne metabolomics, inflammation, and comedogenesis: an update. Clinical, Cosmetic and Investigational Dermatology, 2015.
Thiboutot D et al. – New insights into the management of acne: An update from the Global Alliance to Improve Outcomes in Acne Group. Journal of the American Academy of Dermatology, 2009.

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