Evaluation of nasal and oropharyngeal flora in patients with acne vulgaris according to treatment options

Abstract

The aim of this study was to evaluate changes in nasal and oropharyngeal flora in patients with acne during treatments with tetracycline and isotretinoin. Swab specimens were taken from the right and left nasal cavities and oropharynx of 55 patients with acne and 20 healthy volunteers who were admitted to the dermatology department (Etlik Educational and Research Hospital, Ankara, Turkey) before the administration of treatment and in the third month of treatment. Study participants were divided into four groups as follows: patients with acne on topical treatment only, systemic isotretinoin, and systemic tetracycline, and the control group. Of 55 patients with acne, 18 were male and 37 were female. The mean age of the patients and the control group was 22.21 ± 4.22 and 21.95 ± 7.64, respectively. Staphylococcus aureus was isolated from the nasal flora of five patients, normal flora was suppressed in the oropharyngeal cultures of seven patients, and normal flora grew in the cultures of the other 20 patients who were on tetracycline treatment. On the other hand, normal flora grew in the nasal and oropharyngeal cultures of all the patients who were on isotretinoin treatment. Treatment options and follow-up procedures for acne vulgaris may lead to the development of bacterial resistance and damage to flora. In particular, systemic tetracycline treatment leads to changes in flora of the nose and throat in patients with acne with an increased carriage of S. aureus. Therefore, careful attention should be paid to the duration of tetracycline treatment in order to not increase the risk of disturbance of microbial flora.

A systematic review and meta-analysis on Staphylococcus aureus carriage in psoriasis, acne and rosacea

“…With an I 2 of 71 %, heterogeneity was considered to be moderate. Two studies included a control group but did not demonstrate a statistically significant difference in S. aureus nasal colonization rates between patients and healthy controls [ 66 , 69 ]. Basak et al, Fanelli et al and Levy et al found pharyngeal colonization rates of 0.09, 0.33 and 0.26, respectively [ 67 , 70 , 71 ].…”

Assessment of nasal carriage of staphylococcus aureus in patients with acne vulgaris

“…Ozoguz ve ark. 16 benzer çalışmalarında farklı sonuçlar elde etmişlerdir. Akne tedavisi başlandıktan 3 ay sonra isotretinoin kullanan hastaların nazal ve orofaringeal kültürlerinde normal flora izole ederken tetracycline kullanan hastaların kültürlerinde S. aureus izole etmişlerdir.…”

Riscos Da Antibioticoterapia No Tratamento Da Acne Vulgar: A Resistência Do S.AUREUS Pode Ser Um Deles?

“…De modo geral, os antibióticos orais são indicados em casos de acne vugaris classificada como moderada a grave, por apresentarem significativa ação antiinflamatória sobre a Propionibacterium acnes. Ademais, a terapia sistêmica está indicada como tratamento alternativo quando outrosmedicamentos falham ou não são tolerados pelopaciente (6) .…”

“…Contudo, ainda que sejam utilizados há muito tempo e em muitos pacientes com acne, já é bem sabido que os antibióticos afetam a diversidade e a composição da microflora bacteriana natural (6) .…”

“…Estudos mais antigos evidenciaram a resistência contra P. acnes e, mais recentemente, um aumento tem sido relatado na colonização de Staphylococcus aureus, em especial na mucosa da nasofaringe (6) .…”