Elsevier

Clinics in Dermatology

Volume 28, Issue 1, January–February 2010, Pages 2-7
Clinics in Dermatology

The role of Propionibacterium acnes in acne pathogenesis: facts and controversies

https://doi.org/10.1016/j.clindermatol.2009.03.012Get rights and content

Abstract

We have come a long way since 1896, when it was first suggested that Propionibacterium acnes, found in acne lesions, was the cause of acne. Although several lines of evidence suggest the direct role of P acnes in acne, the mechanism by which P acnes contributes to the pathogenesis of acne is debated. The importance of P acnes in the induction and maintenance of the inflammatory phase of acne has been established. Emerging data that inflammatory events occur in the very earliest stages of acne development have reopened the debate about the potential involvement of this microorganism in comedogenesis and acne initiation.

Section snippets

P acnes and its role in acne over the years

P acnes, previously classified as Corynebacterium parvum, has been implicated in the pathogenesis of acne for more than 100 years. It was first incriminated as early as 1896 with the suggestion that the microorganism found in acne lesions was the direct cause of acne,2 and later studies supported its implication in the disease.3 Another study provided proof of the inflammatory properties of P acnes by showing that P acnes injected into sterile keratinous cysts led to their rupture with

The role of P acnes in acne inflammation

Of particular interest in both the understanding of the pathogenesis of acne and the development of therapeutic agents is the onset of inflammation.11 Colonization of the pilosebaceous follicle by P acnes is a major factor for the inflammatory reaction in acne vulgaris; therefore, P acnes has been a major target of therapy in inflammatory acne.

There are several mechanisms by which P acnes may lead to the disruption of the follicular epithelium and subsequent inflammatory reaction (Table 1).12,

The role of P acnes in comedogenesis

The nature and sequence of events in acne initiation have yet to be elucidated. Inflammation has always been considered a secondary event. A study of the evolution of acne lesions showed that inflamed lesions such as papules and pustules develop from clinically “noninflamed” lesions (open and closed comedones),49 and the microcomedone is considered as the primary acne lesion.

The formation of comedones results from keratinocyte hyperproliferation and reduced desquamation due to increased

Conclusions

Recent research in acne pathogenesis has led to a greater understanding of the disease. Indeed, acne vulgaris is currently considered an inflammatory skin disease of the pilosebaceous unit rather than a keratinocyte/hyperproliferative disorder.12 Although several lines of evidence suggest the direct involvement of P acnes in acne, little is known about the mechanism by which P acnes contributes to the pathogenesis of acne.55

Controversy has long existed on whether inflammation events occur

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