Acne management in the era of antibiotic resistance

Acne vulgaris, a prevalent chronic skin disorder, affects hair follicles and sebaceous glands, with a significant global burden, especially among adolescents and young adults. This review underlines the roles of the skin microbiome and antibiotic treatments in managing acne. Propionibacterium acnes, now known as Cutibacterium acnes, is a key bacterium that inhabits the skin and is implicated in acne pathogenesis through its involvement in sebum secretion, comedone formation, and inflammation.
The skin microbiome's complexity, primarily dominated by bacteria like Propionibacterium, Staphylococcus, and Corynebacterium, varies greatly across different skin sites. These microorganisms, including the acne-associated P. acnes, reside in dynamic communities and play critical roles in skin health and disease. Concerns about antibiotic resistance have intensified, as P. acnes and other skin commensals adapt to long-term antibiotic exposure, leading to decreased treatment efficacy and potential microbial imbalances. The review advocates for prudent antibiotic use and highlights the necessity of exploring alternative acne treatments that preserve the skin's microbial diversity and reduce resistance development.
Furthermore, the review proposes that understanding the interactions between acne, the skin microbiome, and antibiotic use will enhance treatment strategies and possibly reintroduce a balanced skin microbiome as part of acne management. These insights underline the urgent need for new research into microbiome-friendly therapies that could revolutionize acne treatment, shifting away from reliance on antibiotics towards more sustainable and holistic approaches.