Факторы экспосома в патогенезе акне

Концепция экспосома, сформулированная более пятнадцати лет назад, все чаще обсуждается в современной научной литературе. Под термином «экспосом» понимают совокупную меру воздействия факторов окружающей среды на человека на протяжении всей его жизни (от пренатального периода до смерти) и связанной с ним биологической реакции. Сумма этих факторов оказывает существенное влияние на возникновение, характер течения и эффективность терапии мультифакториальных заболеваний. Кожа представляет собой пограничный орган и постоянно подвергается воздействиям окружающей среды, т. е. является мишенью для экспосома. Влияние компонентов последнего описано при старении кожи, атопическом дерматите, злокачественных новообразованиях кожи. Акне является одним из наиболее распространенных хронических воспалительных дерматозов. В последнее десятилетие отметается рост заболеваемости акне во всем мире, его раннее начало и затяжное течение с поражением взрослых мужчин и женщин. В обзоре представлен анализ данных об эффектах компонентов экспосома – характера питания, приема лекарственных препаратов, стресса, поллютантов – на характер течения акне. Особое внимание уделено немногочисленным данным о характере взаимодействия между компонентами экспосома и микробиома кожи, который, с одной стороны, участвует в патогенезе дерматозов, в т. ч. акне, а с другой – изменяется под влиянием факторов экспосома, выступая посредником между окружающей средой и организмом человека. Поиск факторов окружающей среды имеет под собой, по крайней мере, две цели: обнаружение потенциальных патогенетических звеньев, силы их взаимосвязи с клиническими проявлениями заболевания для разработки новых методов терапии, нацеленных на новые мишени, а также создание и рекомендация охранительного режима в отношении факторов с доказанным действием на течение заболевания пациентам, страдающим акне.

1. Miller G.W., Jones D.P. The nature of nurture: refining the definition of the exposome. Toxicol Sci. 2014;137(1):1–2. https://doi.org/10.1093/toxsci/kft251.

2. Wild C.P. The exposome: from concept to utility. Int J Epidemiol. 2012;41(1):24–32. https://doi.org/10.1093/ije/dyr236.

3. Wild C.P. Complementing the genome with an “exposome”: the outstanding challenge of environmental exposure measurement in molecular epidemiology. Cancer Epidemiol Biomarkers Prev. 2005;14(8):1847–1850. https://doi.org/10.1158/1055-9965.EPI-05-0456.

4. Rappaport S.M. Genetic factors are not the major causes of chronic diseases. PLoS ONE. 2016;11:e0154387. https://doi.org/10.1371/journal.pone.0154387.

5. Passeron T., Krutmann J., Andersen M.L., Katta R., Zouboulis C.C. Clinical and biological impact of the exposome on the skin. J Eur Acad Dermatol Venereol. 2020;34(4 Suppl.):4–25. https://doi.org/10.1111/jdv.16614.

6. Moran T.P. The External Exposome and Food Allergy. Curr Allergy Asthma Rep. 2020;20(8):37. https://doi.org/10.1007/s11882-020-00936-2.

7. Subramanian A., Khatri S.B. The Exposome and Asthma. Clin Chest Med. 2019;40(1):107–123. https://doi.org/10.1016/j.ccm.2018.10.017.

8. Krutmann J., Bouloc A., Sore G., Bernard B.A., Passeron T. The skin aging exposome. J Dermatol Sci. 2017;85(3):152–161. https://doi.org/10.1016/j.jdermsci.2016.09.015.

9. Stefanovic N., Flohr C., Irvine A.D. The exposome in atopic dermatitis. Allergy. 2020;75(1):63–74. https://doi.org/10.1111/all.13946.

10. Gracia-Cazaña T., González S., Parrado C., Juarranz Á., Gilaberte Y. Influence of the Exposome on Skin Cancer. Actas Dermosifiliogr (Engl Ed). 2020;111(6):460–470. https://doi.org/10.1016/j.ad.2020.04.008.

11. Hay R.J., Johns N.E., Williams H.C., Bolliger I.W., Dellavalle R.P., Margolis D.J. et al. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol. 2014;134(6):1527–1534. https://doi.org/10.1038/jid.2013.446.

12. Tan J.K., Bhate K. A global perspective on the epidemiology of acne. Br J Dermatol. 2015;172(1 Suppl.):3–12. https://doi.org/10.1111/bjd.13462.

13. Chen H., Zhang T.C., Yin X.L., Man J.Y., Yang X.R., Lu M. Magnitude and temporal trend of acne vulgaris burden in 204 countries and territories from 1990 to 2019: an analysis from the Global Burden of Disease Study 2019. Br J Dermatol. 2021;10.1111/bjd.20882. https://doi.org/10.1111/bjd.20882.

14. Dréno B., Bettoli V., Araviiskaia E., Sanchez Viera M., Bouloc A. The influence of exposome on acne. J Eur Acad Dermatol Venereol. 2018;32(5):812–819. https://doi.org/10.1111/jdv.14820.

15. Lee Y.B., Byun E.J., Kim H.S. Potential Role of the Microbiome in Acne: A Comprehensive Review. J Clin Med. 2019;8(7):987. https://doi.org/10.3390/jcm8070987.

16. Khmaladze I., Leonardi M., Fabre S., Messaraa C., Mavon A. The Skin Interactome: A Holistic “Genome-Microbiome-Exposome” Approach to Understand and Modulate Skin Health and Aging. Clin Cosmet Investig Dermatol. 2020;13:1021–1040. https://doi.org/10.2147/CCID.S239367.

17. Kulkarni M., Keny D., Potey A.V., Tripathi R.K. A cross-sectional study to assess the incompatible dietary behavior of patients suffering from skin diseases: A pilot study. J Ayurveda Integr Med. 2016;7(2):113–118. https://doi.org/10.1016/j.jaim.2016.06.001.

18. Fulton J.E. Jr., Plewig G., Kligman A.M. Effect of chocolate on acne vulgaris. JAMA. 1969;210:2071–2074. Available at: https://pubmed.ncbi.nlm.nih.gov/4243053.

19. Dreno B., Shourick J., Kerob D., Bouloc A., Taïeb C. The role of exposome in acne: results from an international patient survey. J Eur Acad Dermatol Venereol. 2020;34(5):1057–1064. https://doi.org/10.1111/jdv.16119.

20. Spencer E.H., Ferdowsian H.R., Barnard N.D. Diet and acne: a review of the evidence. Int J Dermatol. 2009;48(4):339–347. https://doi.org/10.1111/j.1365-4632.2009.04002.x.

21. Wolkenstein P., Machovcová A., Szepietowski J.C., Tennstedt D., Veraldi S., Delarue A. Acne prevalence and associations with lifestyle: a cross-sectional online survey of adolescents/young adults in 7 European countries. J Eur Acad Dermatol Venereol. 2018;32(2):298–306. https://doi.org/10.1111/jdv.14475.

22. Cong T.X., Hao D., Wen X., Li X.H., He G., Jiang X. From pathogenesis of acne vulgaris to anti-acne agents. Arch Dermatol Res. 2019;311(5):337–349. https://doi.org/10.1007/s00403-019-01908-x.

23. Monfrecola G., Lembo S., Caiazzo G., De Vita V., Di Caprio R., Balato A., Fabbrocini G. Mechanistic target of rapamycin (mTOR) expression is increased in acne patients’ skin. Exp Dermatol. 2016;25(2):153–155. https://doi.org/10.1111/exd.12885.

24. Melnik B. Dietary intervention in acne: Attenuation of increased mTORC1 signaling promoted by Western diet. Dermatoendocrinol. 2012;4(1):20–32. https://doi.org/10.4161/derm.19828.

25. Melnik B.C. Acne vulgaris: The metabolic syndrome of the pilosebaceous follicle. Clin Dermatol. 2018;36(1):29–40. https://doi.org/10.1016/j.clindermatol.2017.09.006.

26. Smith R.N., Mann N.J., Braue A., Mäkeläinen H., Varigos G.A. A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial. Am J Clin Nutr. 2007;86(1):107–115. https://doi.org/10.1093/ajcn/86.1.107.

27. Marshall K. Therapeutic applications of whey protein. Altern Med Rev. 2004;9:136–156. Available at: https://pubmed.ncbi.nlm.nih.gov/15253675.

28. Pontes Tde C., Fernandes Filho G.M., Trindade Ade S., Sobral Filho J.F. Incidence of acne vulgaris in young adult users of protein-calorie supplements in the city of João Pessoa--PB. An Bras Dermatol. 2013;88(6):907–912. https://doi.org/10.1590/abd1806-4841.20132024.

29. McCarty M. Evaluation and Management of Refractory Acne Vulgaris in Adolescent and Adult Men. Dermatol Clin. 2016;34(2):203–206. https://doi.org/10.1016/j.det.2015.11.007.

30. Chlebus E., Chlebus M. Factors affecting the course and severity of adult acne. Observational cohort study. J Dermatolog Treat. 2017;28(8):737–744. https://doi.org/10.1080/09546634.2017.1329500.

31. Tucker J., Fischer T., Upjohn L., Mazzera D., Kumar M. Unapproved Pharmaceutical Ingredients Included in Dietary Supplements Associated With US Food and Drug Administration Warnings. JAMA Netw Open. 2018;1:e183337. https://doi.org/10.1001/jamanetworkopen.2018.3337.

32. DeKlotz C.M.C., Roby K.D., Friedlander S.F. Dietary Supplements, Isotretinoin, and Liver Toxicity in Adolescents: A Retrospective Case Series. Pediatrics. 2017;140(4):e20152940. https://doi.org/10.1542/peds.2015-2940.

33. Tan J.K., Vasey K., Fung K.Y. Beliefs and perceptions of patients with acne. J Am Acad Dermatol. 2001;44(3):439–445. https://doi.org/10.1067/mjd.2001.111340.

34. Green J., Sinclair R.D. Perceptions of acne vulgaris in final year medical student written examination answers. Australas J Dermatol. 2001;42(2):98–101. https://doi.org/10.1046/j.1440-0960.2001.00489.x.

35. Yosipovitch G., Tang M., Dawn A.G., Chen M., Goh C.L., Huak Y., Seng L.F. Study of psychological stress, sebum production and acne vulgaris in adolescents. Acta Derm Venereol. 2007;87(2):135–139. https://doi.org/10.2340/00015555-0231.

36. Chiu A., Chon S.Y., Kimball A.B. The response of skin disease to stress: changes in the severity of acne vulgaris as affected by examination stress. Arch Dermatol. 2003;139(7):897–900. https://doi.org/10.1001/archderm.139.7.897.

37. Schrom K.P., Ahsanuddin S., Baechtold M., Tripathi R., Ramser A., Baron E. Acne Severity and Sleep Quality in Adults. Clocks Sleep. 2019;1(4):510–516. https://doi.org/10.3390/clockssleep1040039.

38. Misery L., Wolkenstein P., Amici J.M., Maghia R., Brenaut E., Cazeau C. et al. Consequences of acne on stress, fatigue, sleep disorders and sexual activity: a population-based study. Acta Derm Venereol. 2015;95(4):485–488. https://doi.org/10.2340/00015555-1998.

39. Wei B., Pang Y., Zhu H., Qu L., Xiao T., Wei H.C. et al. The epidemiology of adolescent acne in North East China. J Eur Acad Dermatol Venereol. 2010;24(8):953–957. https://doi.org/10.1111/j.1468-3083.2010.03590.x.

40. Suh D.H., Kim B.Y., Min S.U., Lee D.H., Yoon M.Y., Kim N.I. et al. A multicenter epidemiological study of acne vulgaris in Korea. Int J Dermatol. 2011;50(6):673–681. https://doi.org/10.1111/j.1365-4632.2010.04726.x.

41. Kubota Y., Shirahige Y., Nakai K., Katsuura J., Moriue T., Yoneda K. Community-based epidemiological study of psychosocial effects of acne in Japanese adolescents. J Dermatol. 2010;37(7):617–622. https://doi.org/10.1111/j.1346-8138.2010.00855.x.

42. Albuquerque R.G., Rocha M.A., Bagatin E., Tufik S., Andersen M.L. Could adult female acne be associated with modern life? Arch Dermatol Res. 2014;306(8):683–688. https://doi.org/10.1007/s00403-014-1482-6.

43. Jović A., Marinović B., Kostović K., Čeović R., Basta-Juzbašić A., Bukvić Mokos Z. The Impact of Pyschological Stress on Acne. Acta Dermatovenerol Croat. 2017;25(2):1133–1141. Available at: https://pubmed.ncbi.nlm.nih.gov/28871928.

44. Aslan Kayiran M., Karadag A.S., Jafferany M. Psychodermatology of acne: Dermatologist’s guide to inner side of acne and management approach. Dermatol Ther. 2020;33(6):e14150. https://doi.org/10.1111/dth.14150.

45. Ko J.S., Kang H., Woo Choi S., Kim H.O. Cigarette smoking associated with premature facial wrinkling: image analysis of facial skin replicas. Int J Derm. 2002;41(1):21–27. https://doi.org/10.1046/j.1365-4362.2002.01352.x.

46. Shen Y., Wang T., Zhou C., Wang X., Ding X., Tian S. et al. Prevalence of acne vulgaris in Chinese adolescents and adults: a community-based study of 17,345 subjects in six cities. Acta Derm Venereol. 2012;92(1):40–44. https://doi.org/10.2340/00015555-1164.

47. Schäfer T., Nienhaus A., Vieluf D., Berger J., Ring J. Epidemiology of acne in the general population: the risk of smoking. Br J Dermatol. 2001;145(1):100–104. https://doi.org/10.1046/j.1365-2133.2001.04290.x.

48. Yang Y.S., Lim H.K., Hong K.K., Shin M.K., Lee J.W., Lee S.W., Kim N.I. Cigarette smoke-induced interleukin-1 alpha may be involved in the pathogenesis of adult acne. Ann Dermatol. 2014;26(1):11–16. https://doi.org/10.5021/ad.2014.26.1.11.

49. Schraufnagel D.E., Balmes J.R., Cowl C.T., De Matteis S., Jung S.H., Mortimer K. et al. Air Pollution and Noncommunicable Diseases: A Review by the Forum of International Respiratory Societies’ Environmental Committee, Part 2: Air Pollution and Organ Systems. Chest. 2019;155(2):417–426. https://doi.org/10.1016/j.chest.2018.10.041.

50. Ferrara F., Prieux R., Woodby B., Valacchi G. Inflammasome Activation in Pollution-Induced Skin Conditions. Plast Reconstr Surg. 2021;147(1S-2):15S–24S. https://doi.org/10.1097/PRS.0000000000007617.

51. Liu W., Pan X., Vierkötter A., Guo Q., Wang X., Wang Q. et al. A time-series study of the effect of air pollution on outpatient visits for acne vulgaris in Beijing. Skin Pharmacol Physiol. 2018;31(2):107–113. https://doi.org/10.1159/000484482.

52. Araviiskaia E., Lopez Estebaranz J.L., Pincelli C. Dermocosmetics: beneficial adjuncts in the treatment of acne vulgaris. J Dermatolog Treat. 2021;32(1):3–10. https://doi.org/10.1080/09546634.2019.1628173.

53. Dreno B., Martin R., Moyal D., Henley J.B., Khammari A., Seité S. Skin microbiome and acne vulgaris: Staphylococcus, a new actor in acne. Exp Dermatol. 2017;26(9):798–803. https://doi.org/10.1111/exd.13296.

54. Kelhälä H.L., Aho V.T.E., Fyhrquist N., Pereira P.A.B., Kubin M.E., Paulin L. et al. Isotretinoin and lymecycline treatments modify the skin microbiota in acne. Exp Dermatol. 2018;27(1):30-36. https://doi.org/10.1111/exd.13397.

55. Dréno B., Pécastaings S., Corvec S., Veraldi S., Khammari A., Roques C. Cutibacterium acnes (Propionibacterium acnes) and acne vulgaris: a brief look at the latest updates. J Eur Acad Dermatol Venereol. 2018;32(2 Suppl.):5–14. https://doi.org/10.1111/jdv.15043.

56. Leung M.H.Y., Tong X., Bastien P., Guinot F., Tenenhaus A., Appenzeller B.M.R. et al. Changes of the human skin microbiota upon chronic exposure to polycyclic aromatic hydrocarbon pollutants. Microbiome. 2020;8(1):100. https://doi.org/10.1186/s40168-020-00874-1.

57. Borrel V., Thomas P., Catovic C., Racine P.J., Konto-Ghiorghi Y., Lefeuvre L. et al. Acne and Stress: Impact of Catecholamines on Cutibacterium acnes. Front Med (Lausanne). 2019;6:155. https://doi.org/10.3389/fmed.2019.00155.

58. Morvan P.Y., Vallee R. Evaluation of the effects of stressful life on human skin microbiota. Appl Microbiol Open Access. 2018;4:01. https://doi.org/10.4172/2471-9315.1000140.

59. Smith R.P., Easson C., Lyle S.M., Kapoor R., Donnelly C.P., Davidson E.J. et al. Gut microbiome diversity is associated with sleep physiology in humans. PLoS ONE. 2019;14(10):e0222394. https://doi.org/10.1371/journal.pone.0222394.

60. Fournière M., Latire T., Souak D., Feuilloley M.G.J., Bedoux G. Staphylococcus epidermidis and Cutibacterium acnes: Two Major Sentinels of Skin Microbiota and the Influence of Cosmetics. Microorganisms. 20207;8(11):1752. https://doi.org/10.3390/microorganisms8111752.

61. Sfriso R., Egert M., Gempeler M., Voegeli R., Campiche R. Revealing the secret life of skin – with the microbiome you never walk alone. Int J Cosmet Sci. 2020;42(2):116–126. https://doi.org/10.1111/ics.12594.

62. Holland K.T., Bojar R.A. Cosmetics: what is their influence on the skin microflora? Am J Clin Dermatol. 2002;3(7):445–449. https://doi.org/10.2165/00128071-200203070-00001.