Characterization and Analysis of the Skin Microbiota in Acne: Impact of Systemic Antibiotics.

Seo-Yeon Park,Sungjoo Kim,Hei Sung Kim,Se Hoon Lee

doi:10.3390/jcm9010168

Abstract

Systemic antibiotics are extensively used to control moderate to severe acne. Hence, it is crucial to understand their impact on the skin microbiota, which is supposedly perturbed. The purpose of this study was to compare the makeup and diversity of the skin microbiota in acne patients before and after taking oral antibiotics. A longitudinal cohort study was performed on 20 participants with moderate to severe facial acne with no recent use of oral and topical antibiotics/retinoids. Patients were prescribed oral doxycycline, 100 mg, twice daily for six weeks. Skin areas on the cheek were sampled for 16S ribosomal RNA gene sequencing at baseline, and after six weeks of doxycycline treatment. Ten males and 10 females aged 11 to 44 years with a median Investigator’s Global Assessment score of 3 (moderate) were enrolled. At baseline, Cutibacterium acnes (formerly Propionibacterium acnes) was the most dominant species followed by Staphylococcus epidermidis. Acne severity showed a positive correlation with the abundance of Cutibacterium acnes. Across all subjects, antibiotic treatment reduced clinical acne grades and was associated with a 1.96-fold reduction in the relative abundance of Cutibacterium acnes (p = 0.01, 95% CI −22% to −3%). Marked changes were also identified in other bacterial species, such as Cutibacterium granulosum (formerly Propionibacterium granulosum), which increased by 4.46-fold (p = 0.02, 95% CI 0.004% to 0.9%) in the treated samples. In general, antibiotics administration was associated with an increase in bacterial diversity (alpha diversity). Principal coordinates analysis showed mild clustering of samples by patient (analysis of similarity, R = 0.135, p = 0.04) whereas there was scant clustering with treatment (ANOSIM, R = 0.005; p = 0.29). In conclusion, we found individuals with acne to have a unique microbial signature. Acne treatment with systemic antibiotics was associated with changes in the composition and diversity of skin microbiota, especially Cutibacterium acnes, which correlates with acne severity. Our study provides insight into the skin microbiota in acne and how it is modulated by systemic antibiotics.

Highlights

Acne is a chronic, inflammatory condition of the pilosebaceous unit
The skin harbors hundreds of microorganisms, and it is highly likely that the overall balance of the bacteria on a person’s skin is as critical as C. acnes in acne development and skin health
The purpose of this study was to provide an overall picture of the influence of oral antibiotics on the composition and diversity of the acne skin microbiota, which is supposedly altered

Summary

Introduction

Inflammatory condition of the pilosebaceous unit (skin). The disease has received much attention with its high prevalence (up to 90% of teenagers are impacted, with the disease frequently continuing into adulthood), with potential for scarring leading to significant social stigma and discrimination. The pathophysiology of acne is obscure, but increased sebum production, abnormal follicular keratinization, and inflammation are thought to contribute to its occurrence. Colonization and triggering by Cutibacterium acnes (C. acnes; formerly called Propionibacterium acnes), a regular occupant of human skin and sebaceous follicles, has been linked with acne through its impact on lipogenesis, comedone formation, and host inflammation [1,2]. The skin harbors hundreds of microorganisms, and it is highly likely that the overall balance of the bacteria on a person’s skin is as critical as C. acnes in acne development and skin health. While the connection between C. acnes and acne is well-described, far fewer studies have examined/analyzed the entire bacterial composition on acne patients’ skin [3,4,5]

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