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American Journal of Clinical Dermatology Jun 2019Acne vulgaris is a chronic skin disorder involving hair follicles and sebaceous glands. Multiple factors contribute to the disease, including skin microbes. The skin... (Review)
Review
Acne vulgaris is a chronic skin disorder involving hair follicles and sebaceous glands. Multiple factors contribute to the disease, including skin microbes. The skin microbiome in the follicle is composed of a diverse group of microorganisms. Among them, Propionibacterium acnes and Malassezia spp. have been linked to acne development through their influence on sebum secretion, comedone formation, and inflammatory response. Antibiotics targeting P. acnes have been the mainstay in acne treatment for the past four decades. Among them, macrolides, clindamycin, and tetracyclines are the most widely prescribed. As antibiotic resistance becomes an increasing concern in clinical practice, understanding the skin microbiome associated with acne and the effects of antibiotic use on the skin commensals is highly relevant and critical to clinicians. In this review, we summarize recent studies of the composition and dynamics of the skin microbiome in acne and the effects of antibiotic treatment on skin microbes.
Topics: Acne Vulgaris; Anti-Bacterial Agents; Drug Resistance, Bacterial; Hair Follicle; Humans; Malassezia; Microbiota; Propionibacterium acnes; Sebaceous Glands; Symbiosis; Treatment Outcome
PubMed: 30632097
DOI: 10.1007/s40257-018-00417-3 -
Boletin Medico Del Hospital Infantil de... 2022Acne is a chronic inflammatory disease of the pilosebaceous unit with multifactorial etiology. Abnormal proliferation of keratinocytes, altered sebum production,... (Review)
Review
Acne is a chronic inflammatory disease of the pilosebaceous unit with multifactorial etiology. Abnormal proliferation of keratinocytes, altered sebum production, inflammation of the sebaceous follicle, and colonization by Cutibacterium acnes have been traditionally implicated. However, the diet has also been highlighted in the pathogenesis because of its direct relation with some biochemical markers and the transcription of specific genes associated with sebaceous gland activity, inflammation, and bacterial proliferation, which together promote the development of the disease, affect the severity of the condition, and modify its response to treatment.
Topics: Acne Vulgaris; Diet; Humans; Inflammation; Propionibacterium acnes; Sebum
PubMed: 35468121
DOI: 10.24875/BMHIM.21000088 -
Giornale Italiano Di Dermatologia E... Dec 2020Acne fulminans (AF) is a rare and severe form of inflammatory acne presenting clinically with an abrupt outburst of painful, hemorrhagic pustules and ulceration, that... (Review)
Review
Acne fulminans (AF) is a rare and severe form of inflammatory acne presenting clinically with an abrupt outburst of painful, hemorrhagic pustules and ulceration, that may or may not be associated with systemic symptoms, such as fever, polyarthritis, and laboratory abnormalities. It typically affects male teenagers with a pre-existing acne. Although the pathogenetic mechanism has not been established yet, a role of genetic, abnormal immunologic response, drugs intake, hormonal imbalance and viral infection, as causal factors, has been identified. AF may occur as a single disease or may be associated with other disorders. Traditionally, AF has been classified, on the basis of the presence of systemic involvement, in "acne fulminans" and acne fulminans "sine fulminans," when no systemic involvement is present. Recently, four clinical variants have been proposed: acne fulminans with systemic symptoms (AF-SS), acne fulminans without systemic symptoms (AF-WOSS), isotretinoin-induced acne fulminans with systemic symptoms (IIAF-SS), isotretinoin-induced acne fulminans without systemic symptoms (IIAF-WOSS). The diagnosis of AF is usually based on clinical history and physical examination. No specific laboratory abnormalities are generally found. In selected cases, biopsy and/or radiologic imaging are helpful for a correct diagnosis. The treatment significantly differs from severe acne according to severity of clinical presentation and possible systemic involvement. Currently, systemic corticosteroids (prednisolone) and retinoids (isotretinoin) represent the first choice of treatment. Dapsone, cyclosporine A, methotrexate, azathioprine, levamisole, and biological agents such as anakinra, infliximab, adalimumab may be considered as alternative therapies in selected cases. Adjunctive topical and physical therapies may also be considered.
Topics: Acne Vulgaris; Acquired Hyperostosis Syndrome; Adolescent; Adrenal Cortex Hormones; Adult; Androgens; Anti-Inflammatory Agents; Arthralgia; Combined Modality Therapy; Debridement; Dermatologic Agents; Diagnosis, Differential; Disease Progression; Female; Humans; Immunosuppressive Agents; Inflammation; Isotretinoin; Lasers, Dye; Low-Level Light Therapy; Male; Photochemotherapy; Propionibacteriaceae; Retinoids; Symptom Assessment; Young Adult
PubMed: 33084268
DOI: 10.23736/S0392-0488.20.06711-5 -
Cutibacterium acnes (Propionibacterium acnes) and acne vulgaris: a brief look at the latest updates.Journal of the European Academy of... Jun 2018While the commensal bacterium Propionibacterium acnes (P. acnes) is involved in the maintenance of a healthy skin, it can also act as an opportunistic pathogen in acne... (Review)
Review
While the commensal bacterium Propionibacterium acnes (P. acnes) is involved in the maintenance of a healthy skin, it can also act as an opportunistic pathogen in acne vulgaris. The latest findings on P. acnes shed light on the critical role of a tight equilibrium between members of its phylotypes and within the skin microbiota in the development of this skin disease. Indeed, contrary to what was previously thought, proliferation of P. acnes is not the trigger of acne as patients with acne do not harbour more P. acnes in follicles than normal individuals. Instead, the loss of the skin microbial diversity together with the activation of the innate immunity might lead to this chronic inflammatory condition. This review provides results of the most recent biochemical and genomic investigations that led to the new taxonomic classification of P. acnes renamed Cutibacterium acnes (C. acnes), and to the better characterisation of its phylogenetic cluster groups. Moreover, the latest data on the role of C. acnes and its different phylotypes in acne are presented, providing an overview of the factors that could participate in the virulence and in the antimicrobial resistance of acne-associated strains. Overall, this emerging key information offers new perspectives in the treatment of acne, with future innovative strategies focusing on C. acnes biofilms and/or on its acne-associated phylotypes.
Topics: Acne Vulgaris; Humans; Propionibacterium acnes
PubMed: 29894579
DOI: 10.1111/jdv.15043 -
American Journal of Clinical Dermatology Sep 2020Our understanding of the role of Cutibacterium acnes in the pathophysiology of acne has recently undergone a paradigm shift: rather than C. acnes hyperproliferation, it... (Review)
Review
Our understanding of the role of Cutibacterium acnes in the pathophysiology of acne has recently undergone a paradigm shift: rather than C. acnes hyperproliferation, it is the loss of balance between the different C. acnes phylotypes, together with a dysbiosis of the skin microbiome, which results in acne development. The loss of diversity of C. acnes phylotypes acts as a trigger for innate immune system activation, leading to cutaneous inflammation. A predominance of C. acnes phylotype IA has been observed, with a more virulent profile in acne than in normal skin. Other bacteria, mainly Staphylococcus epidermis, are also implicated in acne. S. epidermidis and C. acnes interact and are critical for the regulation of skin homeostasis. Recent studies also showed that the gut microbiome is involved in acne, through interactions with the skin microbiome. As commonly used topical and systemic antibiotics induce cutaneous dysbiosis, our new understanding of acne pathophysiology has prompted a change in direction for acne treatment. In the future, the development of individualized acne therapies will allow targeting of the pathogenic strains, leaving the commensal strains intact. Such alternative treatments, involving modifications of the microbiome, will form the next generation of 'ecobiological' anti-inflammatory treatments.
Topics: Acne Vulgaris; Anti-Bacterial Agents; Anti-Inflammatory Agents; Dysbiosis; Humans; Immunity, Innate; Microbiota; Propionibacterium acnes; Skin; Symbiosis
PubMed: 32910436
DOI: 10.1007/s40257-020-00531-1 -
Orthopaedics & Traumatology, Surgery &... Feb 2018Cutibacterium acnes is a commensal skin bacterium, regularly implicated in prosthetic joint infection, particularly of the shoulder. Diagnosis has been improved by... (Review)
Review
Cutibacterium acnes is a commensal skin bacterium, regularly implicated in prosthetic joint infection, particularly of the shoulder. Diagnosis has been improved by progress in bacteriological techniques: longer culture time, liquid medium culture, MALDI-TOF mass spectrography, and universal 16S rRNA PCR, associated by some authors to sonication of ablated implants. C. acnes pathogenicity involves many virulence factors, notably including biofilm formation. C. acnes may lead to infection that is clinically evident or, frequently, relatively asymptomatic. C. acnes is an anaerobic Gram-positive bacterium, susceptible to many antibiotics that are regularly used in bone and joint infection: beta-lactams, quinolone, rifampicin and clindamycin. It shows increasing resistance to clindamycin and natural resistance to metronidazole. Treatment is medical and surgical, associating synovectomy or complete 1- or 2-step revision depending on time to treatment, and antibiotic therapy. Antibiotic therapy is typically for three months with an initial 2-6 weeks' intravenous phase. Prognosis is generally favorable with well-conducted treatment. Late discovery of positive samples after apparently aseptic implant change is an at-risk situation, usually managed by antibiotic therapy, but with late initiation and hence increased risk of failure. Adverse secondary progression requires repeat revision under good conditions.
Topics: Anti-Bacterial Agents; Biofilms; Drug Resistance, Bacterial; Gram-Positive Bacterial Infections; Humans; Joint Prosthesis; Propionibacterium acnes; Prosthesis-Related Infections; Skin
PubMed: 29203432
DOI: 10.1016/j.otsr.2017.05.030 -
Actas Dermo-sifiliograficas Mar 2017Acne is a chronic inflammatory disease whose psychosocial effects can greatly impair quality of life. Various scales are used to classify the severity of acne, and...
Acne is a chronic inflammatory disease whose psychosocial effects can greatly impair quality of life. Various scales are used to classify the severity of acne, and several treatment algorithms are currently applied: no consensus on a common scale or treatment guidelines has been reached. A group of Spanish experts therefore met to identify a scale the majority could accept as the most appropriate for classifying severity and treating accordingly. The group chose the following classifications: comedonal acne, mild or moderate papulopustular acne, severe papulopustular acne, moderate nodular acne, and nodular-cystic acne (or acne tending to leave scars). Consensus was reached on first- and second-choice treatments for each type and on maintenance treatment. The experts also issued specific recommendations on antibiotic use (starting with mild or moderate papulopustular acne), always in combination with retinoids and/or benzoyl peroxide. The use of isotretinoin (starting at severe papulopustular or moderate nodular acne) was also covered.
Topics: Acne Vulgaris; Adolescent; Algorithms; Androgens; Anti-Bacterial Agents; Benzoyl Peroxide; Child; Comorbidity; Female; Gram-Positive Bacterial Infections; Humans; Isotretinoin; Male; Pregnancy; Pregnancy Complications; Propionibacterium acnes; Severity of Illness Index; Spain
PubMed: 27816123
DOI: 10.1016/j.ad.2016.10.001 -
Cell May 2016Biogeography and individuality shape the structural and functional composition of the human skin microbiome. To explore these factors' contribution to skin microbial...
Biogeography and individuality shape the structural and functional composition of the human skin microbiome. To explore these factors' contribution to skin microbial community stability, we generated metagenomic sequence data from longitudinal samples collected over months and years. Analyzing these samples using a multi-kingdom, reference-based approach, we found that despite the skin's exposure to the external environment, its bacterial, fungal, and viral communities were largely stable over time. Site, individuality, and phylogeny were all determinants of stability. Foot sites exhibited the most variability; individuals differed in stability; and transience was a particular characteristic of eukaryotic viruses, which showed little site-specificity in colonization. Strain and single-nucleotide variant-level analysis showed that individuals maintain, rather than reacquire, prevalent microbes from the environment. Longitudinal stability of skin microbial communities generates hypotheses about colonization resistance and empowers clinical studies exploring alterations observed in disease states.
Topics: Bacteria; Bacterial Physiological Phenomena; DNA Viruses; Fungi; Homeostasis; Humans; Microbiota; Propionibacterium acnes; Skin; Skin Physiological Phenomena; Symbiosis; Virus Physiological Phenomena; Viruses
PubMed: 27153496
DOI: 10.1016/j.cell.2016.04.008 -
Microbiome Oct 2018Acne is one of the most common skin diseases worldwide and results in major health care costs and significant morbidity to severely affected individuals. However, the... (Review)
Review
Acne is one of the most common skin diseases worldwide and results in major health care costs and significant morbidity to severely affected individuals. However, the pathophysiology of this disorder is not well understood. Host-microbiome interactions that affect both innate and adaptive immune homeostasis appear to be a central factor in this disease, with recent observations suggesting that the composition and activities of the microbiota in acne is perturbed. Staphylococcus epidermidis and Cutibacterium acnes (C. acnes; formerly Propionibacterium acnes) are two major inhabitants of the skin that are thought to contribute to the disease but are also known to promote health by inhibiting the growth and invasion of pathogens. Because C. acnes is ubiquitous in sebaceous-rich skin, it is typically labeled as the etiological agent of acne yet it fails to fulfill all of Koch's postulates. The outdated model of acne progression proposes that increased sebum production promotes over-proliferation of C. acnes in a plugged hair follicle, thereby driving inflammation. In contrast, growing evidence indicates that C. acnes is equally abundant in both unaffected and acne-affected follicles. Moreover, recent advances in metagenomic sequencing of the acne microbiome have revealed a diverse population structure distinct from healthy individuals, uncovering new lineage-specific virulence determinants. In this article, we review recent developments in the interactions of skin microbes with host immunity, discussing the contribution of dysbiosis to the immunobiology of acne and newly emerging skin microbiome-based therapeutics to treat acne.
Topics: Acne Vulgaris; Dysbiosis; Hair Follicle; Humans; Metagenome; Microbiota; Propionibacterium acnes; Sebaceous Glands; Staphylococcus epidermidis
PubMed: 30285861
DOI: 10.1186/s40168-018-0558-5 -
The Yale Journal of Biology and Medicine Dec 2022Antimicrobial resistance is an increasing public health problem worldwide. The interest of a focus on antimicrobial resistance in acne lies on the facts that acne... (Review)
Review
Antimicrobial resistance is an increasing public health problem worldwide. The interest of a focus on antimicrobial resistance in acne lies on the facts that acne vulgaris (acne) is the most common skin disease worldwide, that the bacterium (, formerly ) plays a key role in the pathogenesis of acne, while at the same time being part of the skin flora, and that antibiotics are commonly recommended for acne treatment. The overuse of topical and/or systemic antibiotics, the long treatment courses used for acne, and the availability of over-the-counter antibiotic preparations, have led to the worldwide emergence of resistant strains in acne patients. In this review, we discuss the epidemiological trends of antimicrobial resistance in acne, the need to avoid the perturbation of the skin microbiome caused by anti-acne antibiotics, and the clinical practice considerations related to the emergence of resistant strains in acne patients. In light of the increasing risk of antimicrobial resistance, raising concerns over the misuse of antibiotics, prescribing patterns can be a critical target for antibiotic stewardship efforts. Also, the selection of non-antibiotic therapies for acne, whenever possible, may offer significant advantages.
Topics: Humans; Anti-Bacterial Agents; Drug Resistance, Bacterial; Acne Vulgaris; Skin; Propionibacterium acnes
PubMed: 36568833
DOI: No ID Found