From the Guidelines
Acne is not primarily an infection, though bacteria can play a role in its development. Acne is a complex skin condition that occurs when hair follicles become clogged with oil and dead skin cells. The primary cause is excess sebum (oil) production, abnormal shedding of skin cells that line the follicles, and inflammation. While Propionibacterium acnes (now called Cutibacterium acnes) bacteria that naturally live on the skin can contribute to inflammation in acne lesions, the condition itself is not classified as an infectious disease. This is supported by the guidelines of care for the management of acne vulgaris, which recommend multimodal therapy combining multiple mechanisms of action, including topical retinoids, benzoyl peroxide, and topical antibiotics 1.
Key Points in Acne Management
- The use of topical antibiotics is recommended, but not as monotherapy, to prevent the development of antibiotic resistance 1.
- Benzoyl peroxide is recommended for patients with acne, as it has antibacterial properties and can help reduce the risk of antibiotic resistance 1.
- Topical retinoids are also recommended, as they can help normalize skin cell turnover and reduce inflammation 1.
- Systemic antibiotics, such as doxycycline, may be recommended for patients with moderate to severe acne, but their use should be limited to reduce the development of antibiotic resistance and other complications 1.
Treatment Approach
The treatment of acne often involves a combination of topical and oral medications, as well as lifestyle changes. A comprehensive treatment approach is typically more effective than antibiotics alone, as it addresses multiple aspects of the condition, including excess sebum production, abnormal skin cell shedding, and inflammation. This approach may include the use of over-the-counter products containing benzoyl peroxide or salicylic acid, as well as prescription medications such as topical retinoids, antibiotics, and hormonal therapies 1.
Importance of Multimodal Therapy
The guidelines of care for the management of acne vulgaris emphasize the importance of multimodal therapy, which involves combining multiple treatments to address different aspects of the condition 1. This approach can help improve treatment outcomes and reduce the risk of antibiotic resistance and other complications. By understanding that acne is a multifactorial skin condition rather than a simple infection, healthcare providers can develop effective treatment plans that address the underlying causes of the condition, rather than just its symptoms.
From the FDA Drug Label
In severe acne, doxycycline may be useful adjunctive therapy. Propionibacterium acnes The FDA drug label does not directly answer if acne is an infection, but it mentions Propionibacterium acnes as a microorganism that doxycycline is active against, and doxycycline may be useful as an adjunctive therapy in severe acne 2, 2.
- Key points:
- Doxycycline is used as an adjunctive therapy in severe acne.
- Propionibacterium acnes is a microorganism that doxycycline is active against.
From the Research
Definition of Acne
- Acne is a chronic skin disorder involving hair follicles and sebaceous glands 3
- It is an inflammatory disease of the pilosebaceous unit of the skin that primarily involves the face and trunk 4
Role of Microorganisms in Acne
- Cutibacterium acnes (C. acnes, formerly named Propionibacterium acnes) is recognized as a key factor in acne development, regulating inflammatory and immune pathways 5
- The skin microbiome in the follicle is composed of a diverse group of microorganisms, including Propionibacterium acnes and Malassezia spp., which have been linked to acne development 3
- Dysbiosis, or the imbalance in skin microbiome homeostasis, may play a role in acne pathogenesis 5
Is Acne an Infection?
- Acne is not typically considered a traditional infection, but rather a complex interplay between skin microorganisms, sebum production, and inflammation 6
- While microorganisms such as C. acnes play a role in acne development, the condition is not solely caused by a bacterial infection 5, 3
- Antibiotics targeting C. acnes have been used to treat acne, but their use is associated with risks such as antimicrobial resistance and dysregulation of the skin microbiome 5, 3
Treatment of Acne
- Topical therapies such as retinoids, benzoyl peroxide, and azelaic acid are first-line treatments for acne 4
- Systemic agents such as oral antibiotics, hormonal therapies, and isotretinoin may be used for more severe disease 4
- The use of antibiotics to treat acne is associated with risks such as antimicrobial resistance, and their use should be limited to 12 weeks or less 6