Why doesn't patients with chronic acne's body lower sebum production itself? ### Background My cousin has had nodular acne for at least 9 years. Her sebum plugs usually causes bumps on, and inflame, the skin, before the sebum emerges or can be extracted with a comedo extractor. Occasioanlly, this happens without inflammation. ### Dermatologist's Feedback He said that topical retinoids open pores to help expel the trapped sebum, but only oral treinoin (E.g. accutane) can dwindle sebum production. ### Question We forgot to ask him why the body (on its own) doesn't slack sebum production ? We're assuming the body's ability to detect the inflammation and acne nodes, and to adjust sebum production?

Short answer there is no feedback mechanism to tell the body it is overproducing, inflammation can have a huge number of causes, many of which could actually be worsened by decreased sebum production.

Also "overproduction" is a misleading term; it is overproduction compared to the norm for the population and may be perfectly normal for that individual. It is like asking why redheads don't start growing black hair when surrounded by surrounded by people with black hair.