Microbiome and Acne: What You Need to Know to Treat Your Patients
Updated: Mar 25
It is well-known that Propionibacterium acnes – abbreviated as P. acnes – (now known as Cutibacterium acnes) is associated with the development and severity of acne lesions on the skin. However, very little research has been done on the entire microbiome of acne-prone skin. For this reason, we are still uncovering novel treatment approaches to better manage and prevent acne, which take into account the complex system of living organisms that inhabit the skin.
This article will focus on the relationship between the skin’s microbiome and acne, as well as the effect of this relationship on current and future acne treatment therapies.
Bacteria Play a Crucial Role in Acne Development and Management
We know that, like the gut and other parts of the body, the skin is home to a diverse group of microorganisms that have a direct effect on its health and appearance. These living organisms can have both positive and negatives effects on the skin, and are directly affected themselves by the environment in which they live. This combination of microbiota (living organisms) and their environment is what is referred to as a microbiome.
We currently understand that there are four main phyla of bacteria that live on human skin: Actinobacteria, Firmicutes, Proteobacteria, and Bacteroidetes. The two most commonly discussed genera related to acne are Propionibacteria and Staphylococci. A 2016 study found that the relationship between P. acnes and Staphylococci bacteria may be more complex than previously thought, signalling a need for continued research on the specific bacteria and environmental conditions that may contribute to or cause acne. Researchers also found that the strain of P. acnes bacteria may influence its role in acne.
The study, which observed changes in skin microbiota of 55 people with acne-prone skin, found that several factors affected the populations of bacteria on the skin. These included the region of the face (forehead, temples, cheeks, and chins), sebum production, the severity of acne, and pH and temperature of the skin.
Interestingly, findings from this study found evidence that Staphylococci bacteria were most abundant on skin with acne lesions compared to skin without acne, regardless of facial region. As the severity of acne increased, so did the number of Staphylococci on the skin. Conversely, P. acnes bacteria accounted for less than two percent of the total number of bacteria on all skin samples. However, it was found that P. acnes is more abundant within sebaceous follicles, where it affects the growth of various strains of Staphylococci bacteria.
While more research is needed to better understand how the microbiome of the skin affects the presence of acne lesions, these findings indicate interactions between P. acnes and Staphylococci, which may change the way we approach acne treatment in the future.
How to Treat Acne By Targeting Bacteria
There is still more research needed in this area, since there is still much more to learn about the specific organisms that inhabit the skin. What we do know is that certain topical and oral ingredients can treat acne by targeting certain strains of bacteria and controlling their populations on the skin.
Some of the most common antibacterial ingredients that are currently used to treat acne include benzoyl peroxide, salicylic acid, and silver. In the past, topical antibiotics have been used, but due to the growing problem of antibiotic resistance, this is no longer a common treatment. Retinoids have also been used as a topical treatment for acne, which block Toll-like receptor 2 from being activated by P. acnes and therefore triggering an inflammatory response.
Because P. acnes bacteria primarily inhabits sebaceous glands within the skin, other treatments and preventative measures include the use of alpha hydroxy acids and retinoids to keep pores clean and free of oil and debris on which P. acnes could otherwise thrive.
Acne Treatments of the Future
Based on current evidence, researchers are in the testing stages of developing an acne vaccine that would reduce the population of P. acnes bacteria on the skin, as well as inhibit the cascade of inflammation that it causes. Mice trials have revealed that an acne vaccine could target and inhibit the activation of CAMP factor 2, in which P. acnes plays a direct role. CAMP factor 2 appears to be crucial for P. acnes growth and survival and also triggers an inflammatory response from the skin.
Research trials involving human skin are the next step in the development of this vaccine, which might be a reality within the next decade, or possibly sooner.
We’re still not sure of which microorganisms live on human skin. There are trillions of microbiota, including various strains of the same organism, that live on our skin and within our bodies that can affect the skin. As more research is done in this area, we will hopefully be able to develop more effective treatments for chronic skin diseases like acne, eczema, rosacea, and psoriasis.
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