The microbiome in preadolescent acne: Assessment and prospective analysis of the influence of benzoyl peroxide

Abstract

Background/Objectives The pathogenesis of preadolescent acne has not been well studied, and it is uncertain if Cutibacterium acnes is a predominant organism in the microbiome in this age group. The aim of this study was to analyze the microbiome of preadolescent females and to assess whether benzoyl peroxide impacts the microbiome. Methods The study enrolled girls, aged 7‐12 years, with evidence of at least six acne lesions who had not been previously treated. Participants’ skin surface of forehead, cheeks, nose, chin, left retroauricular crease, and extruded contents of a comedonal lesion were sampled at baseline. Participants used benzoyl peroxide 4% wash for 6‐8 weeks and returned for skin surface sampling and extraction collection. Microbiome analysis was performed using 16S ribosomal RNA gene amplicon sequencing on all swab and lesional extraction samples. Results Fifty‐one participants were enrolled with a median IGA score of 2 (mild). Changes in microbiome diversity were associated with increasing age and number of acne lesions (P = 0.001). C. acnes had higher abundances on forehead and nose, as opposed to cheeks and chin (P = 0.009). Bacterial diversity (alpha diversity) of the skin microbiome was comparable between preadolescent at baseline and after treatment with benzoyl peroxide. Conclusion This is the first large assessment characterizing female acne microbiome in early and late preadolescence. Results show that preadolescent acne can vary in its microbial profile, reflecting surrounding changes associated with the onset of puberty. Although benzoyl peroxide use was associated with decreased acne counts, its effect on microbial diversity was not demonstrated in our study.

The Skin Microbiome: A New Actor in Inflammatory Acne

“…As regards alternative treatments to isotretinoin and antibiotics, a study by Ahluwalia et al in 2019 indicated that the antiseptic benzoyl peroxide (BPO), an over-the-counter acne treatment with bactericidal, anti-inflammatory, and comedolytic properties, did not affect microbial diversity [45]. However, these data need to be confirmed as a smaller-sized study-including only five preadolescent females with acne treated with BPO-found that microflora diversity decreased after treatment [46].…”

Features of the Skin Microbiota in Common Inflammatory Skin Diseases

“…Atopic dermatitis (AD) is a chronic, recurrent inflammatory skin disease that commonly occurs in children but can also affect adults [ 41 , 42 , 43 ]. The incidence of AD is increasing, and this disease is thought to affect 5–20% of children and 1–3% of adults worldwide [ 41 , 42 ].…”

“…Atopic dermatitis (AD) is a chronic, recurrent inflammatory skin disease that commonly occurs in children but can also affect adults [ 41 , 42 , 43 ]. The incidence of AD is increasing, and this disease is thought to affect 5–20% of children and 1–3% of adults worldwide [ 41 , 42 ]. Microbiome studies in patients with AD have shown reduced biodiversity of bacterial communities and a significant increase in colonization by Staphylococcus aureus , compared with healthy subjects, in whom colonization by this species is rare.…”

Yin and Yang: A disrupted skin microbiome and an aberrant host immune response in hidradenitis suppurativa

“…did not significantly affect the presence of skin commensals. 215,216 From the acne literature, daily use of BPO washes on the face did not change microbial diversity, 217 but daily application of a BPO containing cream did decrease α-diversity. 218 As epidemiological data indicate that increases in the number of prescriptions and antibiotic use are closely followed by increased antibiotic resistance, it becomes even more relevant to determine which microbes are critical players in HS pathophysiology.…”