Acne, the Skin Microbiome, and Antibiotic Treatment

Haoxiang Xu; Huiying Li


Am J Clin Dermatol. 2019;20(3):335-344. 

In This Article

Conclusions and Outlook

Although the pathogenesis mechanisms of acne have not yet been fully elucidated, it is recognized that P. acnes and inflammatory response play important roles in the development of the disease. The use of bactericidal and anti-inflammatory antibiotics remains an important strategy for treating acne. Thus, rational selection of antibiotics according to the classification of P. acnes strains and corresponding drug susceptibility is preferred. However, this recommendation has not yet gained sufficient attention in clinical practice.

Given the rapid emergence of antibiotic resistance on the global scale and considering the effects of antibiotic use on the human microbiome, alternative clinical practice to antibiotic prescription in treating microbe-related diseases has become critical. A recently published study suggested a potential vaccination approach against acne by targeting Christie–Atkins–Munch–Petersen (CAMP) factor as an antigen.[116] Meanwhile, other studies showed promise in microbiome-based therapies, which may shift the balance among the microbial members, influence the function of immune cells, and prevent diseases while restoring a healthy microbiome.[117–119] In one such study, Nakatsuji et al.[119] showed that reintroduction of coagulase-negative Staphylococcus (CoNS) strains, which produce antimicrobial peptides, to patients with atopic dermatitis decreased S. aureus colonization on the skin. The study 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. Future studies on how to effectively reduce the load of pathogenic microorganisms and inflammation while preserving the balance of the commensal microflora may lead to potential new therapies.