A recent article published in the American Journal of Clinical Dermatology discussed that multiple factors contribute to the pathogenesis ofacne vulgaris, including skin microbes. The skin microbiome in the follicle is composed of a diverse group of microorganisms, of which, Propionibacterium acnes and Malassezia spp. have been implicated in acne development through influencing sebum secretion, comedone formation and inflammatory response.

The authors stated that antibiotics targeting P. acnes have been the mainstay in acne treatment; macrolides, clindamycin and tetracyclines are the most widely prescribed. The use of bactericidal and anti-inflammatory antibiotics remains an important strategy, thus, rational selection of antibiotics according to the classification of P. acnes strains and corresponding drug susceptibility is preferred.

On the other hand, owing to the rapid global emergence of antibiotic resistance and considering the effects of antibiotic use on the human microbiome, alternative clinical recommendations in treating microbe-related diseases are being sought. Additionally, a potential vaccination approach against acne has been suggested by targeting Christie-Atkins-Munch-Petersen (CAMP) factor as an antigen. Meanwhile, microbiome-based therapies – that shift the balance among the microbial members, as well as influence the function of immune cells and prevent diseases while restoring a healthy microbiome, have also shown promise.

This article also reported on studies that demonstrated how commensal skin bacteria can defend against pathogens and suggested that correcting microbiome dysbiosis may potentially be used to treat or improve certain conditions. In inference, it was stated that future studiesthat devise measures to effectively reduce the load of pathogenic microorganisms and inflammation while preserving the balance of the commensal microflora may lead to potential new therapies.

Source: American Journal of Clinical Dermatology. 2019 Jun; 20(3): 335–344. doi: 10.1007/s40257-018-00417-3