Association of Systemic Antibiotic Treatment of Acne With Skin Microbiota Characteristics

Abstract

IMPORTANCE Given the widespread use of systemic antibiotics for treatment of moderate to severe acne, it is important to understand the associations of such antibiotic use with changes not only in Cutibacterium acnes (formerly Propionibacterium acnes) but also in the complete bacterial community of the skin. OBJECTIVE To examine the composition, diversity, and resilience of skin microbiota associated with systemic antibiotic perturbation in individuals with acne. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study conducted at an academic referral center in Maryland from February 11 to September 23, 2014, included 4 female participants who had received a recent diagnosis of acne vulgaris, showed comedonal and inflammatory acne on the face, were at least 18 years old, and had no recent use of systemic or topical treatments for acne, including antibiotics and retinoids. Data analysis was performed between July 5, 2017, and November 7, 2018. INTERVENTIONS Participants were prescribed oral minocycline, 100 mg, twice daily for 4 weeks. Skin areas on the forehead, cheek, and chin were sampled for 16S ribosomal RNA gene sequencing at baseline, 4 weeks after starting minocycline treatment, and then 1 week and 8 weeks after discontinuation of treatment. MAIN OUTCOMES AND MEASURES Skin microbiota examined with respect to relative abundance of bacterial taxa, a diversity (represents within-sample microbial diversity), and β diversity (represents between-sample microbial diversity). Acne status evaluated with photography and lesion count. RESULTS Of the 4 patients included in this study, 2 were 25 years old, 1 was 29 years old, and 1 was 35 years old; 2 were white women, 1 was an African American woman, and 1 was an Asian woman. Across all 4patients, antibiotic treatment was associated with a 1.4-fold reduction in the level of Cacnes (difference, −10.3%; 95% CI, −19.9% to −0.7%; P = .04) with recovery following cessation of treatment. Distinct patterns of change were identified in multiple bacterial genera, including a transient 5.6-fold increase in the relative abundance of Pseudomonas species (difference, 2.2%; 95% CI, 0.9%−3.4%; P < .001) immediately following antibiotic treatment, as well asa persistent 1.7-fold increase in the relative abundance of Streptococcus species (difference, 5.4%; 95% CI, 0.3%−10.6%; P = .04) and a 4.7-fold decrease in the relative abundance of Lactobacillus species (difference, −0.8%; 95% CI, −1.4% to −0.2%; P = .02) 8 weeks following antibiotic treatment withdrawal. In general, antibiotic administration was associated with an initial decrease from baseline of bacterial diversity followed by recovery. Principal coordinates analysis results showed moderate clustering of samples by patient (analysis of similarity, R = 0.424; P = .001) and significant clustering of samples by time in one participant (analysis of similarity, R = 0.733; P = .001). CONCLUSIONS AND RELEVANCE In this study, systemic antibiotic treatment of acne was associated with changes in the composition an...

Skin microbiota: Friend or foe in pediatric skin health and skin disease

“…Whether or not the relative abundance of C acnes is greater in acne patients compared to healthy controls, or whether the levels correlate with disease severity, is unclear. Nonetheless, all studies to date support C acnes as a factor in acne pathogenesis . A small pilot study with 8 pre‐adolescent acne patients demonstrated that in addition to C acnes , both Streptococcus and Staphylococcus spp.…”

“…Few studies demonstrate the direct effects of acne treatments on the skin microbiome. In general, benzoyl peroxide, lymecycline, topical clindamycin, isotretinoin, and oral minocycline all decrease the bacterial load on the skin, including C acnes , and increase bacterial diversity on the skin by the end of treatment . These treatments are not specific to C acnes , but instead trigger global diversity changes within the skin microbiome community, changes that may persist well beyond the treatment end date.…”

“…Nonetheless, all studies to date support C acnes as a factor in acne pathogenesis. [67][68][69][70][71][72][73] A small pilot study with 8 preadolescent acne patients demonstrated that in addition to C acnes, both Streptococcus and Staphylococcus spp. are highly abundant compared to age-matched control subjects, suggesting these species may also contribute to acne pathogenesis in this age group.…”

“…In general, benzoyl peroxide, lymecycline, topical clindamycin, isotretinoin, and oral minocycline all decrease the bacterial load on the skin, including C acnes, and increase bacterial diversity on the skin by the end of treatment. 69,[71][72][73] These treatments are not specific to C acnes, but instead trigger global diversity changes within the skin microbiome community, changes that may persist well beyond the treatment end date. For example, isotretinoin leads to a shift in C acnes ribotypes, with an increase in the abundance of healthy strains on the skin for at least 5 months posttherapy.…”

Skin Microbiota Dynamics Following B. subtilis formulation Challenge

“…Several strategies for the manipulation of the skin microbiota have been suggested, including hygiene products [11], antibiotics [12,13], and prebiotics [14]. These methods, however, often suffer from poor e cacy and lack of selectivity towards the pathogenic bacteria [15].…”