Inflammatory skin is associated with changes in the skin microbiota composition on the back of severe acne patients

Abstract

Acne is the most common inflammatory dermatosis, affecting up to 85% of the 11-30 years old world population. [1] This disease is subdivided according to severity graduation, from minor to severe acne, and affects different body localizations from face to back. [2] The mechanisms leading to severe acne, representing up to 20% of acne patients, are still poorly understood, although Cutibacterium acnes (C. acnes) appears as a key player of acne physiopathology.Recently, an increasing interest was observed related to skin microbiota's impact on innate immunity, and subsequently, on inflammatory dermatoses physiopathology. [3,4] Two major studies previously decrypted skin microbiota in acne context; however, this topic remains poorly documented-especially on the back-and the sampling methodologies used were quite controversial. [5][6][7] Indeed, Barnard et al and Fitz-Gibbon et al both described skin microbiome in acne and healthy context, using strip from nose of patients. [8,9] These studies both showed that no clear difference was observed in C. acnes abundance between healthy and acne individuals, whereas recent evidences highlighted a loss of C. acnes subgroups diversity in severe acne context. [10] On the other hand, studying skin bacterial populations using either 16S metataxonomic method or shotgun, to reveal the skin microbial composition, have never been described before in severe back acne context. The present study aims to investigate skin microbiota in patients with severe acne of the back vs healthy controls, sampling two major localizations of acne lesions: the back and the face. | MATERIAL AND ME THODS | Recruitment of healthy volunteers and patientsIn the present clinical study, 24 patients with severe acne of the back and 12 healthy volunteers were enrolled. Regarding the skin type, all Abstract Acne is the most common inflammatory skin disease, affecting up to 85% of the 11-30 years old world population. Skin microbiota appears as a key player involved in several skin dermatoses physiopathology. Here, we show that inflammatory skin is associated with changes in the skin microbiota composition on the back of severe acne patients but also on the face of patients where acne was scored as mild to moderate, comparing with healthy controls. Changes were observed particularly on skin commensals Propionibacteriaceae, Staphylococcaceae and Enterococcaceae families, suggesting the importance of the balance between skin commensals to maintain skin homeostasis and control skin inflammatory process. K E Y W O R D Sacne, inflammatory skin diseases, innate immunity, microbiology, microbiome

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“…Considering that the inflammatory process of acne can be related to the changes in the microbiota composition of the skin, another tool is the assessment of the quantity of porphyrins (endogenous metabolites of C acnes bacteria) in the skin 12. The combination of these procedures allows a complementary determination of the secretory characteristics of the skin and their relation to the appearance of acne 4,11.…”

Caveolin‐1 as a possible target in the treatment for acne

“…Cutibacterium acnes interacts with the skin not only through invading the host cells. This pathogen also constitutively releases extracellular vesicles, which can induce innate immunity and acne‐like phenotype in human epidermal keratinocytes . Similar mechanism based on the S. aureus ‐derived extracellular vesicles was stated to be an important factor in pathogenesis of atopic dermatitis …”

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“…Oral antibiotics, although widely prescribed for the back and truncal acne, should be used only when absolutely necessary and for short durations. Not only does overprescription contribute to microbial resistance, antibiotics can disrupt gut flora and the gut-skin axis and the resulting intestinal dysbiosis, and worsening of acne [12]. Topical retinoids are highly effective and are recommended as first line therapy in mild-to-moderate acne; however, they can be associated with significant skin dryness, erythema, and even development of dermatitis [13].…”