Skin microbiome in patients with acne

In the past few years, our formulation of the role of Cutibacterium acnes in the pathophysiology of acne has undergone a paradigm shift. According to modern concepts, this disease is caused by not C. acnes hyperproliferation, but an imbalance between various phylotypes of this microorganism that develops due to changes in the skin microbiome composition. Antibiotics are medicines that are usually used to treat this disease. However, the need to use them for a long time, which causes skin dysbacteriosis, increasing resistance to antibiotics, as well as new understanding of the pathophysiology of acne encourage to change the direction of acne treatment. The use of topical benzoyl peroxide and antibiotic combination products not only improves the effectiveness of therapy, especially for inflammatory acne, but also prevents the development of antibiotic resistant pathogenic microflora. Benzoyl peroxide is a lipophilic substance that concentrates in the skin inside the sebaceous hair follicles, producing benzoic acid and reactive oxygen species. Benzoyl peroxide as an oxidizing agent can suppress the synthesis of proteins and nucleotides, activities of mitochondria in microorganisms through inhibiting their growth and reproduction. The combination of this component and antibiotics contributes to the synergy of their action, and effectively reduces inflammation and acne. As examples, we present the clinical case reports of a 20-year-old patient S., who complained of rashes on the facial skin at puberty, as well as an 18-year-old patient A. with rashes on her face. These cases showed that the topical drug was well tolerated, and the only undesirable side effect reported was a feeling of skin tightness.