How acne treatments impact the skin microbiome?

Treatment of acne can affect the skin microbiome as well as the skin barrier functions – but how so?

In fact, treatments with antimicrobials, which are often used for their antiinflammatory properties, decrease the richness and evenness of the cutaneous microbiome.⁽¹⁾

The bactericidal effects desired against specific strains (such as Cutibacterium acnes) also bring collateral damage to the skin microbiome, which in return may impact acne pathogenesis itself.

The resulting imbalance modifies the skin environment, creating permissible conditions for pathogenic strains of microbes implicated in infection and inflammation to flourish, such as virulent strains of C. acnes (i.e., C. acnes IA1 phylotype) and Staphylococcus aureus, which can strengthen the inflammation.

ACNE TREATMENTS SPECIFICITIES: IMPACTS OF EACH THERAPY

FROM SYSTEMIC TREATMENTS…

With isotretinoin for example, the skin becomes drier ⁽³⁾, the microbiome starts to resemble the composition of bacteria found on atopic skin, with a greater abundance of Staphylococcus and Streptococcus.^(4,5)

…TO TOPICAL ONES

If topical benzoyl peroxide is used, the relative abundances of Staphylococcus and Cutibacterium can be reduced, as well as the alpha diversity of the skin microbiome. The number of bacterial species and phylogenetic diversity also decrease after treatment with benzoyl peroxide and tretinoin.⁽⁶⁾

Summary of the effects of systemic and topical acne treatments on the skin barrier function and the microbiome

THE ROLE OF DERMOCOSMETICS
DURING ACNE TREATMENTS

Acne-affected skin has a much lower water retention rate and therefore has a much faster water decay, thus creating an even more inhospitable environment for commensal species.⁽¹⁴⁾

Modulation of the skin microbiota composition and environment represents an innovative strategy to maintain or restore microbial homeostasis in case of dysbiosis.

RESTORING THE SKIN EQUILIBRIUM BY USING THE ADEQUATE DERMOCOSMETICS

Microbiome-based therapies, which can shift the balance among the microbial members, influence the function of immune cells, restore the epidermal barrier and prevent diseases while restoring a healthy microbiome, are promising.

Adequate dermocosmetics can effectively improve the skin barrier function to alleviate the acne symptoms, restore and/or maintain a balanced microbiome and reduce the incidence of side effects after treatment. Consequently, the use of appropriate skin care products (according to the type and severity degree of acne) can also improve patients' compliance and tolerance.

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⁽¹⁾ Dreno, B., et al., Skin microbiome and acne vulgaris: Staphylococcus, a new actor in acne. Exp Dermatol, 2017. 26(9): p. 798-803.
⁽²⁾ Rocha, M.A. and E. Bagatin, Skin barrier and microbiome in acne. Arch Dermatol Res, 2018. 310 (3): p. 181-185.
⁽³⁾ Del Rosso, J.Q., Clinical relevance of skin barrier changes associated with the use of oral isotretinoin: the importance of barrier repair therapy in patient management. J Drugs Dermatol, 2013. 12 (6): p. 626-31.
⁽⁴⁾ Kelhala, H.L., et al., Isotretinoin and lymecycline treatments modify the skin microbiota in acne. Exp Dermatol, 2018. 27(1): p. 30-36.
⁽⁵⁾ Powers, C.E., et al., Microbiome and pediatric atopic dermatitis. J Dermatol, 2015. 42 (12): p. 1137-42.
⁽⁶⁾ Coughlin, C.C., et al., The preadolescent acne microbiome: A prospective, randomized, pilot study investigating characterization and effects of acne therapy. Pediatr Dermatol, 2017. 34 (6): p. 661-664.
⁽⁷⁾ Chien, A.L., et al., Association of Systemic Antibiotic Treatment of Acne With Skin Microbiota Characteristics. JAMA Dermatol, 2019. 155 (4): p. 425-434.
⁽⁸⁾ Foti, C., et al., Contact dermatitis to topical acne drugs: a review of the literature. Dermatol Ther, 2015. 28 (5): p. 323-9.
⁽⁹⁾ Thiele, J.J., et al., Benzoyl peroxide depletes human stratum corneum anti-oxidants. Journal of Dermatological Science, 1998. 16.
⁽¹⁰⁾ Dreno, B., et al., The Skin Microbiome: A New Actor in Inflammatory Acne. Am J Clin Dermatol, 2020. 21(Suppl 1): p. 18-24.
⁽¹¹⁾ Kosmadaki, M. and A. Katsambas, Topical treatments for acne. Clin Dermatol, 2017. 35(2): p. 173-178.
⁽¹²⁾ Latter, G., et al., Targeted Topical Delivery of Retinoids in the Management of Acne Vulgaris: Current Formulations and Novel Delivery Systems. Pharmaceutics, 2019. 11 (10).
⁽¹³⁾ Pechere, M., et al., The antibacterial activity of topical retinoids: the case of retinaldehyde. Dermatology, 2002. 205 (2): p. 153-8.
⁽¹⁴⁾ Yamamoto, A., K. Takenouchi, and M. Ito, Impaired water barrier function in acne vulgaris. Arch Dermatol Res, 1995. 287 (2): p. 214-8.
⁽¹⁵⁾ Laquieze, S., J. Czernielewski, and M.J. Rueda, Beneficial effect of a moisturizing cream as adjunctive treatment to oral isotretinoin or topical tretinoin in the management of acne. J Drugs Dermatol, 2006. 5 (10): p.985-90.
⁽¹⁶⁾ Fourniere, M., et al., Staphylococcus epidermidis and Cutibacterium acnes: Two Major Sentinels of Skin Microbiota and the Influence of Cosmetics. Microorganisms, 2020. 8 (11).
⁽¹⁷⁾ Chandan, N., et al., A new era of moisturizers. J Cosmet Dermatol, 2021. 20 (8): p. 2425-2430.
⁽¹⁸⁾ Blaak, J., et al., A Long-Term Study to Evaluate Acidic Skin Care Treatment in Nursing Home Residents: Impact on Epidermal Barrier Function and Microflora in Aged Skin. Skin Pharmacol Physiol, 2015. 28 (5): p. 269-279