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American Journal of Clinical Dermatology

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01-07-2000 | Leading Article

Is Acne an Infection of Blocked Pilosebaceous Follicles?

Implications for Antimicrobial Treatment

Authors: Dr E. Anne Eady, Jonathan H. Cove

Published in: American Journal of Clinical Dermatology | Issue 4/2000

Abstract

A model is proposed which is based on the assumption that acne is due to infection of functionally blocked pilosebaceous follicles by propionibacteria. Noninflamed lesions, which are first visible during the adrenarche in acne-prone individuals, do not contain propionibacteria. Comedogenesis appears to be independent of bacterial infection and may be driven by high levels of bioactive interleukin-1α derived from ductal hyperkeratinocytes. The stimulus which triggers interleukin-1α production is unknown. Formalin killed Propionibacterium acnes failed to stimulate production of the cytokine by cultured human keratinocytes in vitro.

Inflamed lesions are thought to arise from microcomedones, but the initiating events are unknown. Evidence that propionibacteria are involved in the generation of inflammatory lesions is inconclusive. The cellular infiltrate is consistent with a type IV hypersensitivity response to one or more persistent lesional antigens, not necessarily bacterial. The potent adjuvant activity of P. acnes would up-regulate the immune response to any antigen which came into contact with the mononuclear cell infiltrate.

Antibiotics are widely used in the treatment of acne, and their effects in selecting a predominantly resistant commensal population are well recognized. Although they reduce numbers of propionibacteria on the skin, other modes of action may contribute to or explain their therapeutic efficacy. At a time when there is global concern that antibiotic resistance rates in common bacterial pathogens may threaten our future ability to control bacterial infections, practices which promote the spread of antibiotic-resistant bacteria must be fully justified. A thorough reappraisal of the role of propionibacteria in acne is overdue. It is likely that further experimental work is needed to confirm or refute that P. acnes is aptly named.

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Title: Is Acne an Infection of Blocked Pilosebaceous Follicles?
Implications for Antimicrobial Treatment
Authors: Dr E. Anne Eady
Jonathan H. Cove
Publication date: 01-07-2000
Publisher: Springer International Publishing
Published in: American Journal of Clinical Dermatology / Issue 4/2000
Print ISSN: 1175-0561
Electronic ISSN: 1179-1888
DOI: https://doi.org/10.2165/00128071-200001040-00001

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Is Acne an Infection of Blocked Pilosebaceous Follicles?

Implications for Antimicrobial Treatment

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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