Will targeted microbiome modulation in the skin be the future of acne vulgaris treatment?

Throughout our lives, we encounter a multitude of microbes, but only a limited number of them become integral components of the specialized ecosystem that makes up our bodies. In particular, members of the skin microbiota play a key role in maintaining homeostasis and ensuring optimal skin function. Changes in its composition and the specific species present are often associated with the onset of various disease states. A prime example of this phenomenon is acne vulgaris, where the skin microbiota, in particularly the role of C. acnes, has long been suspected.¹

The recent systematic review by Podwojniak et al.² sought to critically evaluate this question through a systematic review, to summarize the related knowledge published to date, and to raise awareness of the possibility of targeted and systematic microbiota modulation as a potential therapeutic approach to treat this condition.

The authors conducted a systematic search of the PubMed and SCOPUS databases, selecting 26 high-quality studies for inclusion in their analysis. One of the contributions of this study is its comprehensive review of the key microbial players in acne pathogenesis. They provide data that the majority of available studies indeed confirm that either C. acnes, or certain ribotypes within the species, are associated with the disease compared to healthy skin.³ This reinforces the notion of a pathogenic role for C. acnes, despite the fact that the bacterium also plays an important role as a member of the healthy skin microflora.⁴

In diseases where the microbiota changes are important factors, dysbiosis is frequently linked to changes in alpha diversity, which quantifies the species richness in a particular sample. Currently, there is a paucity of data regarding the variation of alpha diversity with the development of acne lesions, thus it is evident that systematic, large, well-controlled studies are imperative for the advancement of this field in the near future.

Available therapeutic modalities employed in the treatment of acne principally target the inflammatory processes associated with lesion development, the microbial component and sebum production.⁵ The latter, in turn, exerts an indirect influence on lipophilic microbes by modulating sebum levels. This article summarizes acne treatments that are known to affect the cutaneous microbiome, and summarizes their findings. While the analysis indicated that only benzoyl peroxide exhibited a substantial impact on microbiota composition, this may be attributable to the limited amount of data available for other treatments currently in use. However, given the established efficacy of this molecule in the treatment of acne, these results substantiate the notion that modifying the composition of the microbiota constitutes a promising approach in the management of this condition.

The authors' exploration of novel treatments, including topical probiotics and plant derivatives, underscores the potential for future research in this area. These approaches may offer a means to directly modulate dysbiosis and, consequently, inflammation, while preserving microbial diversity and maintaining a healthy skin microbiome. However, it is important to acknowledge the numerous challenges that currently impede progress in this domain. The long-term implications of modifying the skin microbiome remain to be fully elucidated, and the potential for unintended consequences on skin health and immunity is a salient concern. The heterogeneity of study types, sampling techniques and microbiome classifications poses a significant challenge to the generalizability of findings, underscoring the pressing need for standardized methodologies in microbiome research. Consequently, future studies should prioritize the enrolment of larger, more uniform cohorts and the implementation of consistent analytical approaches. The proposed personalized approaches in microbiome modulation is also particularly interesting. The development of specialized diagnostic tools to assess an individual's cutaneous microbiome and its alterations is crucial for informed treatment decisions.

None.

None.