From the Guidelines
Infection in acne is a secondary effect, resulting from the multifactorial pathogenesis involving follicular hyperkeratinization, sebum production, and microbial colonization with Cutibacterium acnes. The term "downstream" is not typically used in medical literature to describe this relationship, with "secondary" or "complication" being more appropriate medical terminology. According to the guidelines of care for the management of acne vulgaris 1, acne primarily begins with follicular hyperkeratinization, increased sebum production, and colonization by Cutibacterium acnes. Infection occurs when bacteria multiply excessively in clogged pores, triggering inflammation, which can lead to pustules and more severe inflammatory lesions. Key factors contributing to acne development include:
- Increasing age during adolescence
- Family history of acne
- Oily skin type Treatment typically addresses both the primary factors and potential infection through:
- Topical retinoids (adapalene, tretinoin)
- Benzoyl peroxide to kill bacteria
- Sometimes antibiotics like clindamycin or doxycycline for more severe cases. Understanding this progression helps explain why comprehensive acne treatment targets multiple aspects of the condition rather than just treating infection alone, as emphasized in the guidelines of care for the management of acne vulgaris 1.
From the Research
Infection in Acne
- Infection in acne is a result of bacterial colonization of hair follicles by Propionibacterium acnes (P. acnes) 2.
- The term "downstream effect" is not typically used in medical literature to describe the relationship between infection and acne.
- A more accurate description might be that infection is a contributing factor to the development of acne, as it is one of the four main pathogenic factors involved in the disease, along with increased sebum production, altered keratinization, and inflammation 2, 3.
Treatment of Acne
- Topical therapies, such as retinoids, benzoyl peroxide, and antibiotics, are commonly used to treat mild to moderate acne 4, 3, 5.
- Combination therapies, which target multiple pathways of acne formation, may offer greater therapeutic benefit than monotherapies 4, 5, 6.
- Oral antibiotics, hormonal therapies, and isotretinoin may be used to treat more severe cases of acne 2, 3.
Role of Infection in Acne Treatment
- Antibiotics, such as clindamycin and erythromycin, are often used in combination with other topical therapies to treat acne 4, 5, 6.
- The use of antibiotics in acne treatment can lead to the development of bacterial resistance, highlighting the importance of using combination therapies that include benzoyl peroxide or other non-antibiotic agents 5.