It turns out undigested collagen blocking growing gland cells might sometimes be causing the blackheads seen in common acne, not just excess sebum, as had long been assumed. After the publication of a 2018 paper, researchers suggest genetic mutations that inhibit the collagen reshaping process could be one of the underlying culprits in acne.
The scourge of teenagers through the ages, acne has long been thought to flare up when glands secrete too much lubricating sebum, which mixes with dead skin cells and blocks hair follicles. However, in 2017 and 2018, a number of high-profile clinical trial failures of treatments that dampen sebum production suggest there is a need to revisit the basic science.

The authors point out that prior to their paper, only one missense mutation in MMP14 [had] been reported in Winchester Syndrome patients. The corresponding author, A*STAR Acne and Sebaceous Gland Program Research Director Maurice van Steensel, explains that changes to the gene that programs the body to create the MMP14 enzyme which breaks down collagen causes the skeletal changes, and the problems that cause severe acne, scarring and osteoporosis.

Right enzymes to reshape collagen

Sebaceous glands may be struggling to grow without the right enzymes that help to reshape collagen in the extracellular matrix around them. As the main component of connective tissues in skin, bones, tendons and ligaments, collagen fibers attached to cells form much of the cement that holds the body together. During growth, tissues are continually breaking it down and building new strands to change shape; a process known as remodeling.
Young cells known as progenitor cells must digest collagen to move into glands attempting to expand into the extracellular matrix. If collagen remodeling is impair, the cells that would normally move into the gland might get stuck in an area called the junctional zone near the skin surface. The cells would keep dividing, but be immobilize. As a result, the junctional zone may expand and form a comedo (blackhead).
Acne is kicked off by hormone-induce stimulation of sebaceous gland growth; which explains why acne occur in roughly 80% of people between the ages of 11 and 30; so the period when hormonal lead growth is at its peak. Once stimulated, a few factors could lead to acne causing comedone formation; hence problems with the movement of these cells into the new gland; so excessive growth signaling, or defects in the way still forming gland cells develop, van Steensel explains.
At the Acne and Sebaceous Gland Program, drugs for acne are now being teste on zebrafish models of Winchester Syndrome. “If drugs used to treat acne can correct some features associated with this devastating disorder; hence they will have a good indication that they are targeting tissue remodeling pathways, van Steensel explains.

More collagen in black skin

As a result, it’s researchers will be following research based on the collagen findings and observing the implications for Asian skin. Darker skinned people, says van Steensel, including Asian populations, have more collagen in their skin. It’s one of the reasons Asian skin also tends to resist aging, but it also leads to more severe acne and scarring as extra collagen makes collagen remodeling more difficult.
Asian skin types also tend to produce pigment after inflammation more readily. Treatments for acne are a multi-billion-dollar industry. From antibiotics and hormonal therapies to anti-inflammatory agents and dietary supplements, there is a bewildering array of choices. International guidelines recommend using a topical antiseptic and topical retinoids as first-line therapy.
However, if the acne doesn’t response, patients are prescribe antibiotics and in severe cases; so oral retinoids that have many undesirable side effects. Cutibacterium acnes (formerly known as Propionibacterium acnes) is think to colonize comedones, causing inflammation. Antibiotics can kill the bacteria, however, acne appears to respond even when, C. acnes forms a resistance to the treatment.
It’s possible, says van Steensel, that the antibiotics are actually working by dampening; hence the patient’s immune response to the bacteria, or the antibiotics may promote tissue remodeling; so rather than eliminating the bacteria itself. However, van Steensel concludes that studying the effect of diet on acne is very difficult; hence because current treatments seem to work across the board; so in people with different genetic susceptibility and lifestyles.
Acne has earned its place on this list, van Steensel says. The psychological burden of acne is high. It frequently impairs the self-esteem of affected individuals as it negatively impacts their employability and ability to maintain romantic relationships. Acne is difficult to conceal and can leave life-long scars, so I think it qualifies as a very serious condition.