Your skin has a microbiome. Could it be recalibrated to combat acne vulgaris?

Changes in the skin microbiome are associated with acne vulgaris (AV), yet only a few bacteria have been studied. Now, a new study published in Dove Press is suggesting there may be significant differences in the skin microbiome of AV patients compared to healthy individuals with decreased microbial diversity in AV patients. The researchers found no notable changes in the proportion of Cutibacterium acnes between the two cohorts. The same was true for rare bacteria. The findings underscore the need for further investigation into specific strains of Cutibacterium acnes, the role of Staphylococcus epidermidis and its implications for AV pathogenesis. Additionally, the study revealed how physiological factors such as sebum levels can affect microbial composition with increased sebum potentially favouring Staphylococcus epidermidis. The authors write that these insights contribute to understanding the dysbiosis associated with AV and can serve as foundation for future research and the development of new therapeutic approaches.For this investigation, 144 participants were recruited between November 2022 and March 2023. The cohort included 36 AV patients and 108 healthy controls. Skin samples were collected from the left cheek after standardized preconditioning. DNA was extracted and microbial diversity was assessed by the Shannon index to assess alpha diversity. A lower index suggests fewer species.The results revealed significant differences in microbial diversity, with AV patients exhibiting a markedly lower Shannon index compared to controls. The relative abundance of Cutibacterium acnes, a bacterium commonly associated with AV, showed no significant differences between the two groups. However, the prevalence of Staphylococcus epidermidis was notably higher in AV patients. “This study serves as a springboard for future research to better understand the clinical and/or therapeutic relevance of the findings,” said Dr. Shannon Humphrey, a clinical associate professor in the Department of Dermatology & Skin Science at the University of British Columbia. “This study highlights significant differences in the skin microbiome of Indonesian patients with and without acne vulgaris. Authors found decreased microbial diversity in the skin of the acne patients and a higher prevalence of a bacteria called staph epidermidis. While this study highlights some specific and measurable differences in these particular patients, it points to the need for more information to understand the clinical and therapeutic relevance of these findings.”The current study identified a negative correlation between microbial diversity and sebum levels, suggesting that increased sebum production may favour the growth of staph epidermidis, potentially exacerbating the condition. The researchers theorize that an imbalance in the relative abundance of the entire skin microbiome (dysbiosis) may contribute to acne vulgaris by affecting innate and adaptive immune responses within pilosebaceous follicles. The specific roles of individual microorganisms in the pathogenesis of acne vulgaris have not been well studied. Staphylococcus aureus and Staphylococcus epidermidis have been well-studied due to their proximity to the skin. However, the authors note that many other minor skin microorganisms still lack comprehensive examination. “In this particular study the patients are in Indonesia so it’s uncertain if the findings can be generalized to a global population. Further, patients were included if they had not used acne therapy in the previous 2 weeks although it’s possible that previous therapeutic approaches may have impacted skin microbiome,” Dr. Humphrey told the Medical Post.Dr. Monica Li, a clinical assistant professor in the Department of Dermatology and Skin Science University of British Columbia, said these new findings are notable because they support a growing interest that the skin microbiome and alterations of it contribute to acne vulgaris. “In fact, there are over-the-counter skincare formulations that aim to recalibrate the skin microbiome, to ultimately reduce inflammation that is a key pathogenic factor in acne development,” said Dr. Li. “The clinical implications of this study are that there is a need to evaluate how existing skin care products that support the microbiome can be used as an adjunct to calibrate a healthy skin surface environment.”Topical prescriptions that reduce sebum production, which fuel the growth of Staph epidermidis, is another possible real-world practice that could improve skin microbial health and balance. “It is important to understand how the skin microbiome plays a role in the development of acne, as well as its severity in presentation,” Dr. Li told the Medical Post. “This understanding will help personalize targeted interventions for acne management. Further, it reinforces the role of daily skincare products as a possible effective and long-term adjunct, by helping to recalibrate flora disturbances for improved skin health.References:Sitohang IBS, Legiawati L, Widaty S, et al. Comparative Profile of Microbiome in Normal Skin and Acne Vulgaris Skin Patients. Dove Press.

Your skin has a microbiome. Could it be recalibrated to combat acne vulgaris?

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