Controlling Mast Cell Activation May Help Prevent Scarring in Severe Acne

A new article published in The Journal of Clinical and Aesthetic Dermatology discusses the importance of mast cell control in suppressing postacne scar formation.

For those with severe acne, postacne scarring poses a major aesthetic problem that can have severe impacts on an individual’s quality of life. However, previous research suggests that blocking mast cell function with tranilast can prevent or minimize scarring, researchers explained, despite the involvement of mast cells in the development of acne scare receiving little attention overall.

Although many topical or systemic antibiotics exist to treat acne vulgaris, the common inflammatory skin disease is not fully treatable. It is caused by clogged pores, dead skin, oils, and bacteria that build up in pores and inflame them. Some might also have a genetic predisposition to acne.

Tranilast, which was initially marketed as an anti-allergic agent, can regulate mast cell–derived mediators. “Mast cells contribute to allergic reaction via a number of biological processes and its derived mediators, such as transforming growth factor-β 1 from keloid fibroblasts, which enhances collagen synthesis in keloid fibroblasts in hypertrophic scar tissue, and can regulate the remodeling stages of wound healing,” the study author wrote.

Because of this, the blocking of mast cell function can serve as a satisfactory therapeutic strategy. “The daily combined use of tranilast with antibiotics can treat severe acne and prevents the formation of new scars,” the author added. In comparison, a single treatment with oral and/or externally administered antibiotics can cause atrophic scars.

Tranilast is a daily medical agent that’s been approved in Japan for more than 30 years.

One study found acne lesions in their early stage were detected as prominent activated mast cells producing interleukin-17. Another study noted an increase in the number of mast cells in inflammatory acne lesions. The same study also noted that, “on the sebaceous glands, inflammatory reactions can be influenced not only by purulent inflammation due to bacteria, but also via mast cell activation, probably resulting in scar development.”

Further, these researchers pointed out dermal levels of neuropeptides from mast cells could stimulate lipogenesis of the sebaceous glands. However, because acne normally occurs on the face, examining the lesioned tissue could be difficult. As such, mast cells in acne might not always be histopathologically examined and confirmed.

Acne represents the most common skin condition in the United States, affecting up to 50 million Americans each year, according to the American Academy of Dermatology. The condition usually begins in puberty, while around 85% of those aged 12 to 24 years experiencing at least minor acne at some point in their life. Among those with acne, around 1 of 5 patients will experience scarring.

However, acne’s prevalence in adults is increasing, and the condition affects up to 15% of US women.

A range of treatments currently exist for acne scarring, and treatment plans can vary based on scar types and where they appear on patients’ bodies:

• For depressed acne scars, treatment options can include acne scar surgery or resurfacing procedures like chemical peeling, dermabrasion, and microdermabrasion
• For raised acne scars, dermatologists might recommend injections or surgery, laser therapy, scar creams, gels, and silicone dressings

The study’s author noted that going forward, more research is needed on how mast cell chemical mediators are involved in acne scarring.

“Based on these findings, more attention should be paid to the involvement and control of mast cells in the development of scarring in severe acne,” they concluded.

Reference

Horiuchi, Y. Importance of mast cell activation control for preventing scar formation in severe acne. J Clin Aesthet Dermatol. 2023;16(3):30-31.