Recalcitrant acne vulgaris. Clinical, biochemical and microbiological investigation of patients not responding to antibiotic treatment

Eady, E. Anne; Cove, Jonathan H.; Blake, Joseph A.; Holland, K. T.; Cunliffe, W. J.

doi:10.1111/j.1365-2133.1988.tb02437.x

Cited by 48 publications

(20 citation statements)

References 19 publications

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“…Fortunately, P. acnes is highly sensitive to many antibiotics, and the development of resistance is uncommon. 45 However, strains of P. acnes that are less sensitive to antibiotics have recently become more prevalent. 46,47 The clinical importance of the reduced sensitivity is not known, although concern about the future of antibiotic therapy has been voiced.…”

Section: T Able 2 T Opical and S Ystemic A Ntibiotics U Sed To T Reamentioning

confidence: 99%

Therapy for Acne Vulgaris

Leyden

1997

N Engl J Med

228

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Section: T Able 2 T Opical and S Ystemic A Ntibiotics U Sed To T Reamentioning

confidence: 99%

Therapy for Acne Vulgaris

Leyden

1997

N Engl J Med

228

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“…Propionibacterial resistance to the relevant antibiotics has frequently but – interestingly enough – by no means always been associated with clinical failure [32, 33]. Unkles and Gemmell [11]found inhibition of P. acnes lipase production at sub-MIC concentrations of clindamycin and tetracycline but not of erythromycin.…”

Section: Discussionmentioning

confidence: 99%

Inhibition of Lipase Activity in Antibiotic-Resistant <i>Propionibacterium acnes</i> Strains

Gloor

Wasik²,

Becker³

et al. 2002

Dermatology

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Background and Objective: Erythromycin-sensitive and/or clindamycin-sensitive strains of Propionibacterium acnes show a reduced lipase production at levels below the minimal growth-inhibitory concentration (MIC). The objective of this study was to determine whether erythromycin and clindamycin concentrations far below the MIC inhibit lipase production in P. acnes strains resistant to these antibiotics. Methods: Of 42 P. acnes strains, 10 showed an MIC >256 µg/ml for erythromycin. Two strains showed MICs of 0.19 and 0.25 µg/ml, while the MIC of the remaining strains was ≤0.016 µg/ml. Lipase activity was determined up to a concentration of 192 µg/ml by cultivation on spirit blue agar + lipase reagent. The 10 strains whose erythromycin MIC was >256 µg/ml were also tested for lipase inhibition by clindamycin. While this method fails to differentiate between inhibition of lipase production and inhibition of lipase activity, the absence of inhibition of lipase activity rules out inhibition of lipase production. Results: Inhibition of lipolysis by sub-MIC concentrations was demonstrated only for clindamycin in 3 P. acnes strains. However, lipase inhibition was seen only at the dilution level immediately below the MIC. Conclusions: Resistant P. acnes strains with high erythromycin and/or clindamycin MICs can be ruled out to show in vitro inhibition of lipase production at antibiotic concentrations far below the MIC.

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“…Since D = F / V and at steady state D = μ , published values for the follicular volume and sebum excretion rate can be used to approximate the doubling time of P. acnes in vivo . The volume of pilosebaceous follicles has been reported to be 0.12–0.26 mm 3 cm −2 [35] on the forehead, and typical values for the sebum excretion rate have been given as 0.25–2.8 μ g cm −2 min −1 at this site [36] with higher rates in subjects with acne. The measured rate is the average of the sebum output from hundreds of follicles.…”

Section: Relationship Between P Acnes Growth Rate and Rate Of Sebmentioning

confidence: 99%

A Honey Trap for the Treatment of Acne: Manipulating the Follicular Microenvironment to ControlPropionibacterium acnes

Eady

Layton

Cove

2013

BioMed Research International

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Today, as 40 years ago, we still rely on a limited number of antibiotics and benzoyl peroxide to treat inflammatory acne. An alternative way of suppressing the growth of Propionibacterium acnes is to target the environment in which it thrives. We conjecture that P. acnes colonises a relatively “extreme” habitat especially in relation to the availability of water and possibly related factors such as ionic strength and osmolarity. We hypothesise that the limiting “nutrient” within pilosebaceous follicles is water since native sebum as secreted by the sebaceous gland contains none. An aqueous component must be available within colonised follicles, and water may be a major factor determining which follicles can sustain microbial populations. One way of preventing microbial growth is to reduce the water activity (a w) of this component with a biocompatible solute of very high water solubility. For the method to work effectively, the solute must be small, easily diffusible, and minimally soluble in sebaceous lipids. Xylose and sucrose, which fulfil these criteria, are nonfermentable by P. acnes and have been used to reduce water activity and hence bacterial colonisation of wounds. A new follicularly targeted topical treatment for acne based on this approach should be well tolerated and highly effective.

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Recalcitrant acne vulgaris. Clinical, biochemical and microbiological investigation of patients not responding to antibiotic treatment

Cited by 48 publications

References 19 publications

Therapy for Acne Vulgaris

Therapy for Acne Vulgaris

Inhibition of Lipase Activity in Antibiotic-Resistant <i>Propionibacterium acnes</i> Strains

A Honey Trap for the Treatment of Acne: Manipulating the Follicular Microenvironment to ControlPropionibacterium acnes

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