isotretinoin and Gram-Positive-Bacterial-Infections

From the first reliable descriptions of acne in the early 19th century, dermatologists recognized it as a disease of the pilosebaceous follicle. Until the middle of the 20th century, they hypothesized that seborrhoea, follicular keratosis and microorganisms could be individually responsible for the acne lesions. Inflammation was only regarded as the final and inescapable step of the acne process. Although the importance of these factors has been reevaluated, recent works still regarded them as mandatory. In the 1970s, the onset of isotretinoin dramatically improved acne management. It also provided great opportunities for a better understanding of the pathogenic factors of acne. This study analyzes their genesis and development from the seminal contributions until recent advances.

Topics: Acne Vulgaris; Animals; Anti-Bacterial Agents; Dermatitis, Seborrheic; Dermatologic Agents; Diet; Gram-Positive Bacterial Infections; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; Hormones; Humans; Inflammation; Isotretinoin; Propionibacterium acnes; Sebum; Skin Diseases, Bacterial; Vitamin A

Skin colonization by antibiotic-resistant propionibacteria is commonplace among acne patients globally. Increasing attention is now being paid to how resistance rates might be reduced to preserve the future efficacy of antibiotics, especially erythromycin and clindamycin in acne therapy.. To assess the efficacy of oral isotretinoin in the control of antibiotic-resistant propionibacteria.. Acne patients (72 in the U.K., 62 in the U.S.A.) colonized with high numbers of antibiotic-resistant propionibacteria were sampled before, during and 12 weeks after oral isotretinoin therapy. Propionibacterial samples were collected from five acne-prone skin surface sites using a detergent scrub method and from the anterior nares using moistened swabs. Total and antibiotic-resistant propionibacteria were enumerated by viable counting on media with and without selective antibiotics.. After 16 weeks of oral isotretinoin therapy, mean population densities of viable propionibacteria and variants resistant to erythromycin, clindamycin or tetracycline had fallen by more than 90% at all skin sites and in the nares. The sole exception was a smaller reduction in tetracycline-resistant strains on the lower back. In general, greater reductions were observed on skin than in the nares. By the end of the treatment period only three patients (all in Philadelphia) yielded no antibiotic-resistant strains from any site. Post-treatment, propionibacterial counts remained well below pretreatment levels but had begun to recover on the face and in the nares. The recovering propionibacterial population included both susceptible and resistant strains. Changes during and post-treatment at the two centres were similar but not identical.. Oral isotretinoin effectively reduced skin and nasal colonization by antibiotic-resistant propionibacteria. However, viable populations of resistant isolates persisted post-treatment at multiple sites. Novel methods are required to eradicate antibiotic-resistant propionibacteria completely, especially from the nasal reservoir.

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Adult; Anti-Bacterial Agents; Drug Resistance, Bacterial; Female; Gram-Positive Bacterial Infections; Humans; Isotretinoin; Male; Microbial Sensitivity Tests; Middle Aged; Nose; Propionibacterium; Skin Diseases, Bacterial; Treatment Outcome

Acne is a chronic inflammatory disease whose psychosocial effects can greatly impair quality of life. Various scales are used to classify the severity of acne, and several treatment algorithms are currently applied: no consensus on a common scale or treatment guidelines has been reached. A group of Spanish experts therefore met to identify a scale the majority could accept as the most appropriate for classifying severity and treating accordingly. The group chose the following classifications: comedonal acne, mild or moderate papulopustular acne, severe papulopustular acne, moderate nodular acne, and nodular-cystic acne (or acne tending to leave scars). Consensus was reached on first- and second-choice treatments for each type and on maintenance treatment. The experts also issued specific recommendations on antibiotic use (starting with mild or moderate papulopustular acne), always in combination with retinoids and/or benzoyl peroxide. The use of isotretinoin (starting at severe papulopustular or moderate nodular acne) was also covered.

Topics: Acne Vulgaris; Adolescent; Algorithms; Androgens; Anti-Bacterial Agents; Benzoyl Peroxide; Child; Comorbidity; Female; Gram-Positive Bacterial Infections; Humans; Isotretinoin; Male; Pregnancy; Pregnancy Complications; Propionibacterium acnes; Severity of Illness Index; Spain

Topics: Acne Vulgaris; Anti-Bacterial Agents; Benzoyl Peroxide; Dermatologic Agents; Doxycycline; Drug Resistance, Bacterial; Gram-Positive Bacterial Infections; Humans; Isotretinoin; Minocycline; Propionibacterium acnes; Zinc

Retinoids are used in the treatment of inflammatory skin diseases and malignancies, but studies characterizing the in vivo actions of these drugs in humans are lacking. Isotretinoin is a pro-drug for all-trans retinoic acid, which can induce long-term remissions of acne; however, its complete mechanism of action is unknown. We hypothesized that isotretinoin induces remission of acne by normalizing the innate immune response to the commensal bacterium Propionibacterium acnes. Compared with normal subjects, peripheral blood monocytes from acne patients expressed significantly higher levels of Toll-like receptor 2 (TLR-2) and exhibited significantly greater induction of TLR-2 expression following P. acnes stimulation. Treatment of patients with isotretinoin significantly decreased monocyte TLR-2 expression and subsequent inflammatory cytokine response to P. acnes after 1 week of therapy. This effect was sustained 6 months following cessation of therapy, indicating that TLR-2 modulation may be involved in the durable therapeutic response to isotretinoin. This study demonstrates that isotretinoin exerts immunomodulatory effects in patients and sheds light on a potential mechanism for its long-term effects on acne. The modulation of TLR-2 expression on monocytes has important implications in other inflammatory disorders characterized by TLR-2 dysregulation.

Topics: Acne Vulgaris; Adolescent; Adult; Cytokines; Dermatologic Agents; Female; Gram-Positive Bacterial Infections; Humans; Isotretinoin; Leukocytes, Mononuclear; Male; Propionibacterium acnes; Toll-Like Receptor 2; Young Adult

Topics: Acne Vulgaris; Dermatologic Agents; Gram-Positive Bacterial Infections; Humans; Isotretinoin; Propionibacterium acnes; Research

Topics: Acne Vulgaris; Administration, Oral; Anti-Bacterial Agents; Drug Resistance, Multiple; Female; France; Gram-Positive Bacterial Infections; Humans; Isotretinoin; Male; Pregnancy; Propionibacterium acnes; Staphylococcal Infections; Staphylococcus epidermidis

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Drug Resistance, Multiple; Female; Gram-Positive Bacterial Infections; Humans; Isotretinoin; Male; Pregnancy; Propionibacterium acnes; Staphylococcal Infections; Staphylococcus epidermidis

Topics: Acne Vulgaris; Androgen Antagonists; Anti-Bacterial Agents; Estrogens; Gram-Positive Bacterial Infections; Humans; Isotretinoin; Propionibacterium acnes