In this issue of Experimental Dermatology, dr. Melnik presents the hypothesis that acne is caused by inappropriate survival of cells in the sebaceous duct and gland. He proposes in particular that TRAIL mediated apoptosis is inhibited by ductal hypoxia. If it works out, this intriguing idea would suggest interesting new therapies. In my comment, I offer a critical appraisal - the TRAIL to acne pathogenesis might be rather different from what dr. Melnik would have us believe. This article is protected by copyright. All rights reserved.