Is acne really a disease?: a theory of acne as an evolutionarily significant, high-order psychoneuroimmune interaction timed to cortical development with a crucial role in mate choice

Abstract 

Adolescent acne is considered from the perspective of evolutionary psychology with an emphasis on a role in mate choice. The fact that acne, which is almost universal and not a true infection, is (1) initiated at puberty by the action of pubertal hormones on likely distinct, pro-acne follices, and (2) typically resolves in one’s early twenties when prefrontal cortex development is complete, suggests that the condition’s timeframe is meaningful. Acne’s conspicuous localization on the face, and its ability to elicit reflexive disgust and avoidance in observers, suggests a possible role in sexual selection. The pathophysiology of acne is reviewed, and the suggestion made that, far from being a disease, adolescent acne is a normal physiological process – a high-order psychoneuroimmune interaction – that functions to ward off potential mates until the afflicted individual is some years past the age of reproductive maturity, and thus emotionally, intellectually, and physically fit to be a parent.