Why does acne still exist?

Nice piece in the Atlantic last week that asks the provocative question: “why does acne still exist.”  Now, I had not been asking that specific question, but I’ve definitely been thinking more about acne than I have in the past 20+ years now that the signs are popping up on my 13-year old son (not too bad, but there).  Anyway, basic point being that if its just a small bacterial infection on your face, you’d think we’d have figured out how to eliminate it by now.  Alas, not at all so simple:

Some acne 101: You may already know that acne is linked to the bacteriumPropionibacterium acnes, which nestles in the dark, oily, oxygen-deprived crannies of our pores. Acne is also linked to inflammation, overgrowth of the upper skin layer, excess sebum, and depression. Because the root of the problem has long seemed to be a bacterium, antibiotics have been the go-to treatment. Dermatologists are also working on developing something called “antimicrobial peptides” to kill the bacteria — anticipating the day that the bacteria outgrow our current antibiotics, and they fail us.

Still, as millions of people who have used antibiotics in failed attempts know, killing the bacteria doesn’t work for everyone. A study earlier this year found that severity of acne does not necessarily correlate with the amount of P. acneson the skin. It also turns out there are different strains of the bacterium, some of which may cause the more severe cases. It might be too early to say that there are distinct “good” and “bad” strains of the acne bacteria, but it does appear that killing all of them might not be the best plan.

And as for bad acne– forget diet, just blame your parents.  (On the bright side, I think this means my kids should be okay as neither Kim nor I had it too bad):

Eighty percent of cases of severe acne can be traced through inheritance from one’s parents. The role of diet remains disputed among dermatologists, but the most recent research suggests that different diets can influence the way genes that influence acne are expressed. Meanwhile, the idea of developing a vaccine for acne has been floating around for some time — as a way to prime your body so that it doesn’t react so strongly against the bacteria during the height of a breakout.

Still the fact that acne is a human-only disease makes studying it particularly difficult. We can’t recreate it in mice to test vaccines and treatments, or put zits on fruit flies.

I imagine there’s more on the subject that the author of this brief piece did not summarize, but my naive hypothesis is that it has to do very much with the totality of the microbiome on one’s skin.  If very many healthy people have P. acnes, but no acne, perhaps the key is the lack of a differerent bacteria that keeps the P. acnes in check.  Forget vaccines, maybe the solution will be some healthy bacteria that you rub on your skin that out-competes the P. acnes, or at least keeps it from making too much trouble.

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