A global perspective on the epidemiology of acne
Summary
摘要
英文原文
Acne is estimated to affect 94% of the global population, making it the eighth most prevalent disease worldwide. Epidemiological studies have demonstrated that acne is most common in postpubescent teens, with boys most frequently affected, particularly with more severe forms of the disease. This paper aims to provide an update on the epidemiology of acne worldwide. Recent general and institutional studies from around the world have shown that the prevalence of acne is broadly consistent globally (with the exception of specific populations, which are discussed). However, this review highlights that there is a wide range of disparate outcome measures being applied in epidemiology studies, and we emphasize the need to develop a widely accepted, credible, standard assessment scale to address this in the future. In addition we discuss special populations, such as those devoid of acne, as well as the impact of potential determinants of acne on disease epidemiology.
对应中文
据估计，痤疮影响全球94%的人口，是全球第八大流行疾病。流行病学研究表明，痤疮最多见于青春期后的青少年，其中男孩受影响最频繁、发病形式更为严重。本文旨在提供全球痤疮流行病学的最新资料。最近来自世界各地的一般和机构研究表明，全球痤疮的流行趋势大致一致( 具体种群除外 ,下面讨论 )。然而，这篇综述着重显示流行病学研究中应用的结果衡量标准种类宽泛复杂，因此提出我们有必要制定一个被广泛接受的、可信的、标准的评估表，以在未来解决这一评估标准不统一的问题。此外，我们还讨论了特殊人群，如那些没有痤疮的人群，以及面部潜在决定因素对疾病流行病学的影响。
英文原文
Acne vulgaris, or acne, is a common condition with a wide range of potential harms and associated costs. The former include symptomatic discomfort, scarring, emotional and psychosocial distress, occupational consequences and potential psychiatric disturbances including depression and suicide. Identification of individuals at risk of these sequelae can contribute to reducing the morbidity associated with acne.
对应中文
寻常痤疮、或痤疮是一种常见的疾病，具有广泛的潜在危害和相关成本。前者包括症状不适、瘢痕形成、情绪和心理社会困扰、职业后果和潜在的精神障碍 (包括抑郁和自杀)，识别这些后遗症的风险可以有助于降低与痤疮相关的发病率。
Epidemiological studies
流行病学研究
Prevalence studies
流行研究
英文原文
From the mid to late 20th century, the majority of epidemiological studies on acne were performed in the U.S.A. and the U.K. The largest of these was a population-based study of over 20000 Americans whose acne was evaluated by dermatologists or residents.Similar smaller studies were performed in the U.K. with approximately one-tenth the sample size.Studies from that era demonstrated that the age of peak incidence for acne was the late teens, with progressive reduction in prevalence with increasing age. Male patients were more frequently affected, particularly with more severe forms of acne. Seminal studies on adolescent maturation and acne included longitudinal studies in American schoolchildren. These showed that the prevalence and severity of acne increased with pubertal maturation and that comedonal acne predominated in preteens, with increasing inflammatory acne developing during the teen years.
对应中文
从20世纪中后期开始，大多数关于痤疮的流行病学研究都是在美国和英国进行的。其中最大的是一项以人群为基础的研究，对2万多名美国人的痤疮进行皮肤科医生或居民的评估。英国也进行了类似的小型研究，样本量大约是这个时期的十分之一。那个时代的研究表明，痤疮的高发年龄是十几岁左右，随着年龄的增长，患病率逐渐降低。男性患者更容易受到影响，尤其是更严重的痤疮。关于青少年成熟和痤疮的开创性研究包括对美国学龄儿童的纵向研究。这些研究表明，痤疮的患病率和严重程度随着青春期的成熟而增加，粉刺性痤疮在青春期占主导地位，在青少年时期，炎症性痤疮的发病率增加。
General population surveys
一般人口调查
英文原文
Over the past 15 years, various general population prevalence studies on acne have been conducted. Table shows studies published in the English language after 1995, addressing acne prevalence, and with objective means of acne evaluation (not self-rated).The largest of these community-based studies in which participants were examined by dermatologists were performed in China (n=17345),Germany (n=90880) and Egypt (n=8008).Despite the geographical and temporal dispersion of these studies, the prevalence of acne was consistent, with point prevalence rates of 8.1%, 3.9% and 5.4%, respectively. These studies also provided evidence on the peak age (or age range) of acne, putting it within the age range of 16–20 years.Acne prevalence from household surveys ranged from a low of 0.1% and 0.35% in rural villages of Northwest Tanzania and Ethiopia,to a high of 17% in the Iraqi city of Basrah.For the former, these rate variations may reflect differences in case ascertainment–mild acne may be more difficult to diagnose in darker phototypes, and full-body examination was not practical in all cases, leading to possible underdiagnosis of truncal acne. In the latter study, it was not stated whether the evaluators were dermatologists or trained in detection of skin disease.
对应中文
在过去的15年里，人们对痤疮进行了各种一般人群患病率研究。表格显示了1995年后以英语发表的关于痤疮患病率的研究，以及客观的痤疮评估方法（非自评）。在这些由皮肤科医生对参与者进行检查的社区研究中，最大的研究是在中国 ( n=17345 )、德国 ( n=90880) 和埃及 (n=8008) 进行的。尽管这些研究在地理和时间上分散，但痤疮的患病率是一致的，点患病率分别为8.1%、3.9%和5.4%。这些研究也为痤疮的发病高峰年龄 (或年龄范围) 提供了证据，将其置于16 ~ 20岁的年龄范围内。家庭调查的痤疮患病率在坦桑尼亚西北部和埃塞俄比亚的农村低至0.1%和0.35%，在伊拉克城市巴士拉为18%到17%。对于前者，这些发病率变化可能反映了病例确定的差异——轻度痤疮可能在较暗的光照类型下更难诊断，并且全身检查并非适用于所有病例，导致躯干痤疮可能诊断不足。在后一项研究中，没有说明评估者是否是皮肤科医生或受过皮肤病检测培训。
Specific surveys in students and institutions
对学生和院校进行的具体调查
英文原文
Larger studies evaluating sex differences have shown that acne is more prevalent in girls at younger age ranges, with increasing prevalence in boys as they reach puberty.Male subjects also tend to have more severe acne.Following the teenage years, the prevalence in women again tends to be higher than in men.Further analysis of physician visits was conducted in a large dataset representative of the U.S. population from 1979 to 2007, to evaluate acne vulgaris in children aged 6–18 years.There was a significant decrease in the mean age of children seeking treatment over this time frame, with a reduction in age from 15.8 years in 1979 to 15.0 years in 2007. Sex and ethnic stratification revealed that black girls with acne had the lowest mean age, while white boys had the highest. In combination with prior studies showing an association of acne with pubertal onset, these findings suggest an earlier onset of puberty, particularly in black girls.
对应中文
评估性别差异的大型研究表明，痤疮在年轻的女孩中更普遍，随着进入青春期，男孩的患病率增加。男性受试者也倾向于有更严重的痤疮。青少年之后，女性的患病率再次高于男性。对1979年至2007年间代表美国人口的大型数据集进行了进一步的医生就诊分析，以评估6-18岁儿童的寻常痤疮。在此期间，寻求治疗的儿童平均年龄显著下降，从1979年的15.8岁下降到2007年的15岁。性别和种族分层显示，有痤疮的黑人女孩的平均年龄最低，而白人男孩的平均年龄最高。结合以前的研究表明痤疮与青春期的关系，这些发现表明不同人群中青春期开始的早晚，特别是在黑人女孩开始较早。
英文原文
While comparison between studies is fraught with potential confounding factors, one study did evaluate variations in acne prevalence in almost 3000 women of different ethnicities. Recruiting from the general population of four large cosmopolitan cities (Los Angeles, CA, U.S.A.; London, U.K.; Akita, Japan; Rome, Italy), the prevalence of clinical acne varied with ethnicity: African American, 37%; Hispanic, 32%; Asian, 30%; Caucasian 24%; and Continental Indian women, 23%.30 Nevertheless, other environmental factors may account for these differences, as within these groups variation in acne prevalence was observed based on the city of recruitment.
对应中文
虽然研究之间的比较充满了潜在的混杂因素，但一项研究确实评估了近3000名不同种族女性的痤疮患病率的差异。从四个大型国际城市 (美国洛杉矶，美国；英国伦敦，日本秋田；意大利罗马) 的普通人群中招募，临床痤疮患病率因种族而异：非洲裔美国人，37%；西班牙裔，32%；亚洲人，30%；高加索人24%；印度大陆女性，23%。尽管如此，其他环境因素也可以解释这些差异，因为在这些群体中，根据招募城市的不同也能观察到痤疮发病率的差异。
英文原文
When evaluated, the most common extrafacial sites affected by acne were the upper back (52%), upper chest (30%), lower back (22%), shoulders/arms (16%) and neck (8%).These findings are similar to those obtained by researchers from other countries.
对应中文
经评估，痤疮最常见面部以外的部位是上背部（52%）、上胸部（30%）、下背部（22%）、肩部/手臂（16%）和颈部（8%）。这些发现与其他国家的研究人员获得的结果相似。
英文原文
In studies evaluating the course of acne, the mean duration was approximately 2 years,with a median > 1 year.A study of over 600 patients with acne showed that the majority had suffered from acne for more than 2 years.Based on these and other considerations, acne has been increasingly recognized as a potentially chronic disease.
对应中文
在评估痤疮病程的研究中，平均持续时间约为2年，其中中位数>1年。一项对600多名痤疮患者的研究表明，大多数人患有痤疮超过2年。基于这些和其他考虑，痤疮已越来越被认为是一种潜在的慢性病。
英文原文
Scarring is the most concerning of the physical sequelae of acne, as it is persistent and not readily, or easily, reversible. However, scarring resulting from acne has been evaluated in only a few studies. Of these, one of the largest comprised almost 1000 patients with acne. Clinically relevant scarring was observed on the face, chest and back in 55%, 14% and 24% of patients, respectively. Acne duration also correlated with scarring.These findings corroborate those of a U.K. study involving 185 patients with acne, which showed that the severity of acne scarring in each of these regions was associated with prior acne grade and duration of up to 3 years.
对应中文
疤痕是痤疮最令人担忧的生理后遗症，因为它是持久性的，不容易或容易逆转。然而，痤疮引起的疤痕仅在少数研究中得到评估。其中，最大一个研究纳入了1000名痤疮患者。在55%、14%和24%的患者的面部、胸部和背部分别观察到与临床相关的疤痕。痤疮的持续时间也与瘢痕疙瘩相关。这些发现证实了英国一项涉及185名痤疮患者的研究，该研究表明，这些地区痤疮疤痕的严重程度与先前的痤疮级别和持续时间长达3年有关。
**Special populations -**Populations devoid of acne
特殊人群 – 没有痤疮的人群
英文原文
There are three special populations in which the absence of acne may be instructive regarding pathogenesis. Firstly, no acne was observed in two indigenous geographically disparate populations, in Papua New Guinea and Paraguay. During a 7-week study, 494 household visits were conducted and general health examinations performed in 1200 Kitavan islanders in Papua New Guinea. Skin evaluations to detect acne–including the face and torso for men, and face and neck for women–were conducted by a trained physician and no acne was observed, even in the 300 individuals at greatest risk of acne (aged 15–25 years).These islanders were subsistence horticulturalists and fishermen with dietary habits uninflu- enced by Western culture.
对应中文
在三个特殊的人群中，痤疮的缺失可能对发病机制有指导意义。首先，在巴布亚新几内亚和巴拉圭两个地理位置不同的土著人口中没有发现痤疮。在一项为期7周的研究中，在巴布亚新几内亚的1200个基塔万岛居民中进行了494次家庭访问和一般健康检查。检测痤疮的皮肤评估——包括男性的面部和躯干，女性的面部和颈部——由受过培训的医生进行，即使在300名最有可能患痤疮的人（15-25岁）中，也未观察到任何痤疮。这些岛民是靠园艺和渔民为生的，他们的饮食习惯不受西方文化的影响。
英文原文
In a similar study conducted among the Ache of Eastern Paraguay, examination for skin and health disorders was conducted every 6 months for almost 3 years by family practitioners trained in recognition of acne. No active acne was observed in these individuals over that time. The diet of this group consisted primarily of foraged and cultivated foods, wild game and domestic meat, as well as collected forest products. In both instances these non-Westernized populations had minimal exposure to Western foods and the authors suggest that the differences in acne prevalence may be due to differing environmental factors.While the findings of these studies are intriguing, they have not yet been repeated in other indigenous populations. In such cohorts,further evaluation of diet, dairy ingestion, P. acnes phylotypes and loads, and hormonal assessments are all of potential pathogenic interest.
对应中文
在巴拉圭东部的痤疮患者中进行的一项类似研究中，由接受过痤疮识别培训的家庭医生每6个月进行一次皮肤和健康障碍检查，持续近3年。在这段时间内，这些人没有发现活动性痤疮。这一群体的饮食主要包括觅食和栽培食物、野生动物和家畜肉以及采集的森林产品。在这两种情况下，这些非西方人对西方食物的接触都很少，作者认为痤疮患病率的差异可能是由于不同的环境因素。虽然这些研究的发现很有趣，但在其他土著人群中还没有重复。在这些队列中，进一步评估饮食、乳制品摄入、痤疮杆菌系统类型和负荷以及激素评估都是潜在的致病因素。
**Psychological impact of acne -**Psychosocial impact
痤疮对心理的影响 – 心理社会影响
英文原文
As reviewed elsewhere, the psychosocial impact of acne includes adverse impact on multiple dimensions of quality of life. These include effects on self-perception, socialization, emotional health and occupational opportunities, and may be associated with anxiety and depressive symptoms, as well as body dissatisfaction.
对应中文
正如其他地方回顾的那样，痤疮的心理社会影响包括对生活质量的多个方面的不利影响，这些包括对自我认知、社交、情绪健康和职业机会的影响，可能与焦虑和抑郁症状以及身体不满有关。
英文原文
The effect of sex, age and acne location on appearancerelated distress in patients with acne was evaluated in a study of 132 patients attending an acne clinic in the U.K.This study used a self-rated acne severity scale based on Leeds reference photographs for the face, chest and back, and the Derriford Appearance Scale, which measures patient distress and dysfunction in relation to appearance.Greater self-con-sciousness of appearance and negative self-concept was noted in women with acne, and patients over the age of 20 years had greater appearance-related distress than younger individuals. The effect of the anatomical site of acne was of particular interest, as moderate-to-severe acne on the back and chest was correlated with self-consciousness of sexual and bodily appearance, while facial acne was associated with social self-consciousness of appearance. Thus, the location of acne may impact differentially on human relationships–impacting social aspects with facial acne and sexual aspects with truncal acne.
对应中文
在英国一家痤疮诊所对132名患者进行了一项研究，评估了性别、年龄和痤疮位置对痤疮患者外表相关困扰影响。这项研究使用了基于面部、胸部和背部Leeds参考照片的自评痤疮严重程度量表，以及Derriford外观量表，衡量患者与外表相关的痛苦和功能障碍。痤疮患者的自我意识和消极自我概念更强，20岁以上的患者比年轻人的痛苦更大。痤疮解剖部位的影响尤其令人感兴趣，因为背部和胸部的中度至重度痤疮与性和身体外观的自我意识相关，而面部痤疮与社会自我意识的外观相关。因此，痤疮的位置可能会对人际关系产生不同的影响——面部痤疮会影响社会方面，躯干痤疮会影响性方面。
**Psychological impact of acne -**Psychiatric effects
痤疮对心理的影响 – 精神影响
英文原文
Recent investigations highlight important psychiatric comor-bidities–specifically, depression and suicidal risk–affecting a large proportion of patients with acne. The association of ‘problem’ acne with increased risk of anxiety, depression and suicidal ideation has been investigated in several studies in adolescents, and is addressed elsewhere in this supplement.
对应中文
最近的调查强调了影响大部分痤疮患者的重要精神病并发症——特别是抑郁症和自杀风险。“问题”痤疮与焦虑、抑郁和自杀意念增加的风险之间的关系已经在青少年中的几项研究中进行了调查，并在本补充文件的其他地方进行了讨论。
英文原文
Self-rated ‘problem acne’ has been shown to be associated with increased risk of anxiety, depression and suicidal ideation in a New Zealand study, in which 9567 high school students aged 12–18 years completed a questionnaire to evaluate the impact of acne.Problem acne was reported by 14% of students, and clinically relevant depressive symptoms were reported by 14%, anxiety by 5%, suicidal ideation by 24% and suicidal attempts by 8%. Compared with those without problem acne, significant associations were observed, with odds ratios (ORs) and 95% confidence intervals (CIs) of 2.04 (1.70–2.45), 2.30 (1.74–3.00), 1.74 (1.54–1.97) and 1.83 (1.51–2.22), respectively.These results were corroborated in a cross-sectional survey of high school students in Norway involving 3775 students aged 18–19 years.The presence and severity of acne were again self-evaluated, and mental health issues, social impairment and suicidal ideation were evaluated by screening instruments.
对应中文
新西兰的一项研究表明，自评“问题痤疮”与焦虑、抑郁和自杀意念的风险增加有关，其中9567名12-18岁的高中生填写了一份问卷，以评估痤疮的影响。14%的学生报告了问题痤疮，临床相关的抑郁症状占14%，焦虑占5%，自杀意念占24%，自杀未遂占8%。与那些没有痤疮问题的人相比，观察到了显著的相关性，优势比 (OR) 和95%可信区间 (CI) 分别为2.04 (1.70-2.45)，2.30(1.74-3.00)，1.74(1.54-1.97)和1.83(1.51-2.22)。这些结果在对挪威3775名18-19岁学生的横断面调查中得到证实。再次对痤疮的存在和严重程度进行自我评估，并通过筛查工具评估心理健康问题、社会障碍和自杀意念。
英文原文
The New Zealand study included instruments such as the Reynolds Adolescent Depression Scale and the Anxiety Disorder Index of the Multidimensional Anxiety Scale for Children,and specific questions such as, ‘Have you thought about killing yourself or attempted to kill yourself over the past 12 months?’ In the Norwegian study, corresponding instruments used were derived from the Strengths and Difficulties Questionnaire and the Hopkins Symptom Checklist.The prevalence of substantial acne was 14% and was similar in boys and girls. The prevalence of mental health problems was 12% and of suicidal ideation 11%. However, both were significantly associated with increasing self-rated acne severity. Significant associations of substantial acne were observed with suicidal ideation (OR 1.80, CI 1.30– 2.50) and with mental health problems (OR 2.25, CI 1.60– 3.00).
对应中文
新西兰的这项研究包括雷诺青少年抑郁量表和儿童多维焦虑量表焦虑障碍指数等工具，以及诸如“在过去的12个月里你有没有想过自杀或试图自杀”这样的具体问题。在挪威的研究中，使用的相应工具来源于强项和难度问卷和霍普金斯症状自评量表。实质性痤疮的患病率为14%，在男孩和女孩中几乎相同。心理健康问题患病率为12%，自杀意念患病率为11%。然而，两者都与自我分级痤疮严重程度的增加显著相关。观察到实质性痤疮与自杀意念(OR 1.80，CI 1.30-2.50)和精神健康问题(OR 2.25，CI 1.60-3.00)显著相关。
英文原文
The association of suicide attempts with acne has also been investigated by a retrospective cohort study using patient linkage of drug registry data, hospitalization diagnostic codes and cause-of-death information from isotretinoin users in Sweden from 1980 to 2001. This study demonstrated that the stan- dardized incidence ratio for attempted suicide progressively escalated in the 3 years prior to oral isotretinoin medication, suggesting that severe acne itself is a risk factor for attempted suicide.
对应中文
1980年至2001年，瑞典的一项回顾性队列研究也调查了自杀未遂与痤疮的关系，该研究使用了瑞典异维A酸使用者的药物登记数据、住院诊断代码、死因信息和联系年龄。本研究表明，在口服异维A酸前3年，自杀未遂的标准化发生率呈进行性上升，提示严重痤疮本身是自杀未遂的危险因素。
Potential determinants of acne – Diet
痤疮的潜在决定因素 – 饮食
英文原文
The relationship between diet and acne has been controversial, and it has been debated in the literature since the early 1900s.Recently, there has been a surge in studies providing greater insight, with several studies looking into glycaemic index (GI) and diet and their relationship with acne vulgaris, although a systematic review of these studies showed the relationship to be inconclusive.More recently there has been an emphasis on the possible mechanisms through which high-GI foods could affect the actual pathogenesis of an acne lesion.
对应中文
饮食与痤疮之间的关系一直存在争议，自20世纪初以来，文献中就对此进行了辩论。最近，提供更深入见解的研究数量激增，比如，其中几项研究都探讨了血糖指数（GI）、饮食及其与寻常痤疮的关系。尽管对这些研究的系统回顾表明两者之间的关系尚不确定，最近有人强调高GI食物可能通过某种机制影响痤疮病变的实际发病机制。
英文原文
A dietary intervention trial of 32 people with acne, randomized to either a low-GI diet or a control group (instructed to eat a carbohydrate-rich diet), was conducted over 10 weeks. Subjective and objective improvement was observed in both groups, with greater improvement in the intervention group–a 70.9% decrease in the mean inflammatory lesion count com-pared with baseline.Furthermore, sebaceous gland size was reduced in the low-GI diet group, indicating decreased activity and lower levels of sebum production, seborrhoea being a feature of acne vulgaris.
对应中文
其中一项研究对32名痤疮患者进行了为期10周的饮食干预试验，他们被随机分为低GI饮食组和对照组 (指导食用富含碳水化合物的饮食)。两组都观察到了主观和客观的改善，与基线相比、干预组（低GI饮食组）的改善更大：平均炎症皮损计数减少了70.9%。此外，低GI饮食组的皮脂腺大小减少，表明痤疮活动减少、皮脂生成水平降低（皮肤脂溢是寻常痤疮的特征）。
英文原文
The association between acne and dairy consumption has been subject to larger studies. A 4-month case–control study demonstrated that individuals with acne had a diet with a higher GI load and consumed greater amounts of milk and ice cream compared with controls.In a separate case–control study of 205 cases and 358 controls, the association of acne with dairy consumption was further corroborated.Those consuming three or more por- tions of milk per week had a positive correlation with the incidence of acne, although it is not clear exactly how much milk there was per portion. In addition, this correlation was more marked with the consumption of skimmed milk than with whole milk, a finding confirming that of previous investigations.This may in part be explained by the GI of skimmed milk being higher at 4 than that of full-fat milk, which is 3.
对应中文
痤疮与乳制品消费之间的关系受到了更广泛的研究。一项为期4个月的病例对照研究表明，痤疮个体的饮食GI负荷较高，与对照组相比，摄入更多的牛奶和冰淇淋。在一项单独的病例对照研究中，205例患者和358名对照组，痤疮与乳制品消费的关系得到了进一步证实。那些每周摄入三次或三次以上牛奶的人与痤疮的发病率呈正相关，尽管目前尚不清楚特定个人饮用牛奶的确切含量。此外，与全脂牛奶相比，脱脂牛奶的食用量与这种相关性更为显著，这一发现证实了之前的调查结果。这可能部分是因为脱脂牛奶的GI为4、高于全脂牛奶的GI（数值为3）。
英文原文
The role of chocolate in acne remains controversial. A laboratory study using the peripheral blood cells of seven people showed that chocolate consumption (50 g for 4 days) primed these cells to release more of the inflammatory cytokines interleukin (IL)-1b and IL-10 upon stimulation with P. acnes.This suggests that the pathogenesis of acne could involve a complex interplay involving not only P. acnes (discussed below) but also dietary factors, including chocolate or one of its constituents.
对应中文
巧克力在痤疮中的作用仍有争议。一项采用7个人外周血细胞的实验室研究表明，食用巧克力（50g，连续4天）会使这些细胞在痤疮丙酸杆菌刺激下释放更多的炎症细胞因子白细胞介素IL-1b和IL-10。这表明痤疮的发病机制很可能涉及复杂的相互作用，不仅仅是跟痤疮丙酸杆菌（下文讨论）相关，还包括饮食因素、如巧克力或其他饮食成分。
英文原文
There has been a great interest in the possible mechanisms by which foods may affect acne, particularly the involvement of the insulin/IGF-1 signalling pathway. It is suggested that there exists a complex process of food-induced activation of this pathway, which ultimately triggers acnegenic effects such as sebaceous gland lipogenesis.Hyperinsulinaemia, secondary to a high-GI diet, increases the ratio of IGF-1 to insulin-like growth factor-binding protein-3, thus enhancing the effects of IGF-1. In addition, milk and milk products contain IGF-1, and it has been hypothesized that high-GI foods, fats, meat and dairy proteins increase levels of insulin and IGF-1.Levels of insulin and IGF-1 feed into the mammalian target of rapamycin complex-1 and forkhead box O1 signalling pathways, linking nutrient availability to the signalling processes involved in acne pathogenesis.This complex signalling pathway, and how it is involved in acne pathogenesis, is discussed in more detail in another paper in this supplement.
对应中文
研究者们对食物影响痤疮的可能机制非常感兴趣，特别是胰岛素/IGF-1信号通路的参与。研究表明，这一通路存在一个复杂的食物诱导激活过程，最终触发皮脂腺脂肪生成等痤疮效应。高胰岛素血症，仅次于高GI饮食，增加IGF-1与胰岛素样生长因子结合蛋白-3的比率，从而增强IGF-1的作用。牛奶和奶制品中都含有IGF-1；被广泛接受的假设也认为，高GI食物、脂肪、肉类和乳制品蛋白质会增加胰岛素和IGF-1的水平。胰岛素和IGF-1的水平会进入哺乳动物雷帕霉素复合物-1和叉头框蛋白O1信号通路的靶点，将营养素可用性与痤疮发病机制相关的信号传导过程联系起来。这一复杂的信号传导途径，以及它如何参与痤疮发病机制，将在本补充资料的另一篇文章中进行更详细的讨论。
英文原文
Overall these theories provide a plausible and useful guide to the possible mechanisms by which a high-GI diet and dairy products can exert their effects in the pathogenesis of acne and can explain in part why people native to Papua New Guinea and Paraguay, living non-Westernized lifestyles, have no acne compared with more Westernized populations such as in Belgium (Table 2 and Table S1; see Supporting Information). However, they provide only the first step to understanding the link between diet and acne.
对应中文
总体而言，这些理论为高GI饮食和乳制品在痤疮发病机制中发挥作用的可能机制提供了合理而有用的指导，并可以部分解释为什么生活在非西方化生活方式的巴布亚新几内亚和巴拉圭本地人与比利时等西方人相比更少患有痤疮几率 (表2和表S1；见辅助信息)。需要记住的是，以上内容也只是提供了了解饮食和痤疮之间联系的初步佐证。
****Potential determinants of acne –Propionibacterium acnes
痤疮的潜在决定因素 – 痤疮丙酸杆菌
英文原文
Sebaceous follicles provide an ideal anaerobic lipid-rich environment for P. acnes. It has been proposed that P. acnes may exert an effect on naive CD4 cells, initiating their transformation into T helper (Th)17 cells; this results in the production of IL-17, which is expressed in acne lesions.Both vitamins A and D could be effective tools in modulating Th17-mediated diseases such as acne; however, the relevance of IL-17 in the pathogenesis of acne requires further elucidation, and its importance both clinically and epidemiologically is not yet known.In inflammatory acne lesions, P. acnes phylotype IA has been found to be increased, while phylotypes IB and type II are decreased.These findings suggest that P. acnes phylotypes may have different associations with comedones (noninflammatory acne) compared with inflammatory lesions of acne.
对应中文
皮脂腺毛囊为痤疮丙酸杆菌提供了理想的厌氧富脂环境。有研究认为，痤疮丙酸杆菌可能对CD4细胞产生作用，启动其向辅助性T( Th ) 17细胞的转化；这一结果导致IL-17的产生，在痤疮皮损中表达。维生素A和D都可能是调节Th17介导的疾病如痤疮的有效工具；然而，IL-17在痤疮发病机制中的相关性需要进一步阐明，其在临床和流行病学上的重要性尚不清楚。在炎症性痤疮病变中，已发现痤疮丙酸杆菌IA型增加，而IB型和Ⅱ型减少。这些结果表明，与痤疮的炎症性皮损相比，痤疮丙酸杆菌的种族型可能与黑头粉刺(非炎症性痤疮)有不同的关联。
****Potential determinants of acne –Genetics
****痤疮的潜在决定因素 –遗传学
英文原文
The first genome-wide association study of severe teenage acne was undertaken using the Nurses’ Health Study II cohort and comprised European American participants.The results showed the chromosomal locus of 8q24 to be associated with severe teenage acne. This locus has previously been associated with prostate, breast, colon, ovarian and bladder cancers, as well as chronic lymphocytic leukaemia and glioma; the association of this locus with these malignancies may be explained by its proximity to the proto-oncogene Myc. It has also been associated with the gene involved in the upregulation of androgen receptors. This study would have benefited from a larger sample size, as, of the 928 people analysed, only 81 had a history of acne and there were no objective assessments of acne, as data were collected by self-reported questionnaires.
对应中文
第一个关于严重青少年痤疮的全基因组关联研究是使用护士健康研究II队列进行的，由欧美参与者组成。结果显示8q24的染色体位点与严重青少年痤疮相关。该位点以前与前列腺癌、乳腺癌、结肠癌、卵巢癌和膀胱癌以及慢性淋巴细胞白血病和胶质瘤有关；该基因座与这些恶性肿瘤的关联可能是由于其接近原癌基因Myc。这也与雄激素受体上调所涉及的基因有关。这项研究将受益于更大的样本量，因为在928名被分析的人中，只有81人有痤疮病史，而且没有对痤疮的客观评估，因为数据是通过自我报告的问卷收集的。
英文原文
Another study conducted on a cohort containing individuals with and without acne in the Han Chinese population indicated that polymorphisms in cutaneous androgen metabolismregulating genes, HSD3B1 and HSD17B3, increased susceptibility to developing acne vulgaris in this population.
对应中文
另一项针对中国汉族人群中患有和不患有痤疮个体的队列研究表明，皮肤雄激素代谢调节基因HSD3B1和HSD17B3的多态性增加了该人群患寻常痤疮的易感性。
英文原文
Studies have also looked into the genetic variation of P. acnes. A comparative genomic analysis of 82 P. acnes phylotypes isolated from the skin of subjects with and without acne found that phylotypes from the same individual were more closely related to one another than phylotypes from other individuals, suggesting that this could be due to clonal expansion occurring in the environment of individual microbiomes.The genetic basis of P. acnes provides a basis for a greater level of understanding of the differences between the P. acnes commensals in acne skin and those in nonacne skin, and why the presence of P. acnes in some individuals does not cause acne. Further work by the same group conducting metagenetic analyses of P. acnes samples from 49 people with acne and 52 without acne led to the sequencing of P. acnes phylotypes and analysis of 71 P. acnes genomes.The authors found that P. acnes structures were markedly different between the two groups, thus addressing the question of why some people with P. acnes do not develop acne. The advancement of genomic work in both humans and P. acnes is exciting as it provides a platform for the development of more molecular-based therapies, an area not yet exploited in acne treatment.
对应中文
研究还对痤疮丙酸杆菌的遗传变异进行了调查。对有痤疮和无痤疮受试者皮肤分离出的82个痤疮植物型进行比较基因组分析发现，同一个体的种系型之间的亲缘关系比其他个体的种系型更为密切，这可能是由于个体微生物群落环境中发生了克隆所致。痤疮的遗传基础为更大程度地了解痤疮皮肤中与非痤疮皮肤中痤疮相称的差异，以及为什么某些个体中痤疮的存在不会引起痤疮提供了基础。同一组进一步对49例痤疮患者和52例无痤疮患者的痤疮患者样本进行了Meta分析，完成了痤疮患者系统发育类型的测序和71个痤疮患者基因组的分析。作者发现痤疮丙酸杆菌结构在两组间存在明显差异，从而解决了为什么部分痤疮丙酸杆菌患者不发生痤疮的问题。基因组研究在人类和痤疮患者中的进展令人兴奋，因为它为更多的分子疗法的发展提供了平台，这是痤疮治疗中尚未开发的领域。
Conclusions
结论
英文原文
An increasing body of evidence from different countries and regions supports the estimated high prevalence of acne globally, particularly in teenage and early adult years. Furthermore, the potential for a prolonged course of acne along with increased potential for psychosocial, psychiatric and physical sequelae increases the burden of disease.
对应中文
来自不同国家和地区的越来越多的证据支持全球痤疮的高发病率，特别是在青少年和成人早期。此外，痤疮病程延长的可能性以及心理、精神和生理后遗症的可能性增加了疾病的负担。
英文原文
Epidemiological surveys of both populations with acne and those without have provided insight into potential mechanisms of pathogenesis that were previously unclear or unknown. Future investigations to evaluate potential mechanisms of acne in such populations may be instructive in understanding the interplay of intrinsic immunity, diet, hormones and the cutaneous microbiome in acne.
对应中文
对痤疮患者和无痤疮患者的流行病学调查提供了对以往不清楚或未知的潜在发病机制的了解。未来对这些人群痤疮潜在机制的研究可能对理解痤疮的内在免疫、饮食、激素和皮肤微生物之间的相互作用具有指导意义。
REFERENCES
1.Tan JK, Bhate K. A global perspective on the epidemiology of acne. Br J Dermatol. 2015;172 Suppl 1:3-12.