Antibiotic Resistance in Acne: Mechanisms, Complications and Management

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Antibiotic Resistance in Acne: Mechanisms, Complications and Management Melek Aslan Kayiran1   · Ayse Serap Karadag1   · Safaa Al‑Khuzaei2 · WenChieh Chen3,4 · Lawrence Charles Parish5

© Springer Nature Switzerland AG 2020

Abstract Antibiotic resistance in acne was first observed in the 1970s, and since the 1980s has become a major concern in dermatologic daily practice. The mechanisms for this type of resistance include biofilm formation that promotes virulence and the transmission of resistant bacterial strains. Genetic mutations with modification of ribosomal RNA, alteration in efflux pumps, and enzymatic inactivation are able to create resistance to tetracyclines and macrolides. The state of art in acne treatment is no longer to use antimicrobials as monotherapy. There should be a time limit for its use plus the employment of non-antibiotic maintenance. Earlier initiation of oral isotretinoin therapy should be considered in patients with insufficient response to antimicrobials, severe acne, or a history of repeated antimicrobial use. A better understanding of acne pathogenesis, the subtypes of Propionibacterium (also known as Cutibacterium) acnes, homeostasis of the skin microbiota, and the mechanisms of antibiotic resistance would be useful in the selection of narrow-spectrum or species-specific antimicrobials, as well as the non-antimicrobial, anti-inflammatory treatment of acne. A number of novel treatments awaiting clinical proof may include the use of bacteriophages, natural or synthetic antimicrobial peptides, probiotics, and biofilm-targeting agents, as well as the reassessment of phototherapy.

1 Introduction Antibiotic resistance in acne has been observed since the 1970s [1]. The emergence and transmission of antimicrobial resistant strains through long-term repeated use of antimicrobials has become a major concern in contemporary general medicine, as well as in dermatology. The consequences may include the development of treatment resistance or failure of an acne regimen, impairment of the normal mucocutaneous * WenChieh Chen [email protected] 1



Department of Dermatology and Venereology, Istanbul Medeniyet University, School of Medicine, Goztepe Training and Research Hospital, Istanbul, Turkey

2



Department of Dermatology, Hamad Medical Corporation, Rumailah Hospital, Doha, Qatar

3

Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany

4

Department of Dermatology, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan

5

Dermatology and Cutaneous Biology, Jefferson Center for International Dermatology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA



microbiota, and induction of local or systemic opportunistic infections. Advances in our understanding of acne pathogenesis and the subtypes of Propionibacterium (also known as Cutibacterium) acnes may prove helpful for the initiation of other approaches for quelling this sebaceous gland disorder.

2 Propionibacterium acnes in Acne P