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In general, patients with moderate or severe acne tend to have overactive sebaceous glands that produce too much oil, which clogs pores, trapping bacteria in the pore, which then festers, creating painful blemishes

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The proposed mechanisms include upregulation of beta-3 adrenergic receptors in adipose tissue, activation of the cAMP-PKA lipolytic cascade through enhanced catecholamine sensitivity, direct or indirect inhibition of acetyl-CoA carboxylase (ACC) reducing de novo lipogenesis by approximately 43-57% in vitro, and activation of hormone-sensitive lipase (HSL) with increased glycerol release

In fact, the number of ferritin deficiencies was comparable between all groups, ranging from 7 to 16% at 2 years and from 10 to 13% at 3 years of follow-up, which is lower than reported in previous literature (1759% at 24 years after SG) [8, 9, 20, 23,24,25]