Arrange the pathophysiologic events of acne in the correct sequence.

Arrange the pathophysiologic events of acne in the correct sequence.

• A. 1,2,3,4
• B. 2,3,4,1
• C. 2,4,3,1
• D. 3,2,4,1

Answer: (B)

Acne starts with obstruction of the hair follicle due to abnormal keratinization, which creates a plug and forms a microcomedone. That clogged follicle then becomes an ideal site for Propionibacterium acnes to proliferate and metabolize sebum, producing inflammatory byproducts. The presence of bacteria and these inflammatory mediators triggers the body's inflammatory response, leading to papules and pustules around the follicle. Sebum production, driven by androgens, remains high and continues to fuel the environment, perpetuating the cycle and worsening lesions. Because the initiating event is follicular plugging, the sequence that moves from keratinization to bacterial growth to inflammation and finally ongoing sebum activity best reflects the pathophysiology.

Acne starts with obstruction of the hair follicle due to abnormal keratinization, which creates a plug and forms a microcomedone. That clogged follicle then becomes an ideal site for Propionibacterium acnes to proliferate and metabolize sebum, producing inflammatory byproducts. The presence of bacteria and these inflammatory mediators triggers the body's inflammatory response, leading to papules and pustules around the follicle. Sebum production, driven by androgens, remains high and continues to fuel the environment, perpetuating the cycle and worsening lesions. Because the initiating event is follicular plugging, the sequence that moves from keratinization to bacterial growth to inflammation and finally ongoing sebum activity best reflects the pathophysiology.