Immune-mediated inflammatory processes might
involve CD4+ lymphocytes and macrophages that
stimulate the pilosebaceous vasculature precede follicular
hyperkeratinisation.54 Defective terminal keratinocyte
diff erentiation leads to comedo formation under the
infl uence of androgens and qualitative changes in the
sebum lipids that induce interleukin 1 (IL1) secretion