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Acne and the Microbiome

Promising new acne treatments are on the horizon

Many see acne as an inevitable fact of life that comes with being a teenager; though, for acne sufferers, even the occasional breakout can negatively impact self-esteem. As many as 50 million Americans are affected by acne, yet it remains among the least-studied skin conditions. Researchers in San Diego are investigating how the microbiome, the community of bacteria and other microorganisms that live in and on the body, influences the development of acne, which may lead to groundbreaking new preventive treatments.

“The skin is the biggest interface of the body for the microbiome to affect health. There’s a tremendous amount of information that’s been learned about how microbes that live on the skin and within the pores of the skin affect health—not only skin diseases, but general health,” says Richard Gallo, MD, PhD, chair of the Department of Dermatology at UC San Diego School of Medicine. (Doctors in Pediatric Dermatology at Rady Children’s are faculty of the Department of Dermatology and the Department of Pediatrics at UC San Diego.)

For hard-to-control acne, common courses of action include retinoid treatment and antibiotics. Retinoid treatment works by limiting the development of lipids in skin cells; however, it tends to have major side effects and should only be used in severe cases. The problem with antibiotics, whether topical or systemic, is that they knock out both good and bad bacteria and can promote antibiotic resistance.

“What we’ve learned with acne is that it’s not an infectious disease, but a disease where the body’s immune response to the bacteria and the follicle becomes out of balance,” Dr. Gallo says. “The revolutionary part of this is that we’re rethinking how acne happens in people, understanding new genes that cause acne or prevent acne, and then from that learning different strategies for how one might want to treat acne better rather than using antibiotics the way we do today.”

Dr. Gallo and his team are working to develop an acne treatment that would more selectively target bacteria with potentially less harmful side effects. A topical probiotic cream that contains a specific bacteria thought to rebalance the skin microbiome is in early phase clinical trials.

“There’s a lot of promise for major changes in the way we treat acne,” he says. “Acne is a chronic disease that presents itself throughout the lifetime of a person. Almost everyone is affected at some level. We hope to change that”