Follicular hyperkeratinization is a key element in the pathogenesis of acne and a main target of retinoid activity. Hyperkeratinization occurs when the cells of the follicle become cohesive and do not shed normally onto the skin's surface. The result is a microcomedone and subsequent lesions characteristic of acne. Products with retinoid activity, such as tretinoin, adapalene and tazarotene, normalize follicular keratinization, inhibit formation of microcomedones, decrease formation of inflammatory lesions, and speed resolution of comedones. Topical retinoids act within the follicle at the site of changes that lead to the development of microcomedones, reversing the process and stopping the development of lesions. (J Dermatol Treat (2000) 11 (Suppl 2): S5-S8).
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