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Medicine For Acne, Isotretinoin, Shows to Alter Skin Microbiome

acne-web-blog

Isotretinoin, a kind of vitamin A, has been recommended to deal with acne for decades. It reduces oil roduction in the skin, which helps in preventing acne from forming.

But, latest research from Washington University School of Medicine in St. Louis has actually discovered a formerly unknown benefit of the medication. It shifts the skin microbiome of acne patients to more closely resemble that of people with typical skin. The new study is published in the Journal of Investigative Dermatology.

https://infectiousdiseases.wustl.edu/faculty-staff/makedonka-mitreva/https://infectiousdiseases.wustl.edu/faculty-staff/makedonka-mitreva/
02.01.2019

Isotretinoin, a kind of vitamin A, has been recommended to deal with acne for decades. It reduces oil production in the skin, which helps in preventing acne from forming.

But, latest research from Washington University School of Medicine in St. Louis has actually discovered a formerly unknown benefit of the medication. It shifts the skin microbiome of acne patients to more closely resemble that of people with typical skin. The new study is published in the Journal of Investigative Dermatology.

The study clarifies how isotretinoin works and offers info that could result in establishing microbiome-based acne treatments, according to the lead scientists, Makedonka Mitreva, PhD, an associate professor of medicine; and William H. McCoy, MD, PhD, an instructor in medicine, and their colleagues. There is a strong need for such options due to the fact that isotretinoin-- while efficient-- triggers severe birth defects, so doctors must take additional precautions for women of child-bearing age.

Physicians typically recommend antibiotics that target bacteria known as Cutibacterium acnes-- likewise called Propionibacterium acnes-- which is connected with acne. But, such antibiotics can add to the advancement of resistant strains of bacteria and can kill off potentially helpful microbes as well. Isotretinoin is not an antibiotic. It is believed to treat acne by drying out the skin, making it a less inviting place for acne-causing and acne-promoting microbes to thrive. It is the only therapy that can clear acne long term.

" There are oily areas of the skin that support the growth of certain communities of bacteria, and we know that a few of them seem to be connected with acne," stated McCoy, a dermatologist and the research study's first author. "We asked whether we would see fewer of those bad bacteria on the skin after isotretinoin treatment, and we did. However, we also understand that this drug does not work on the bacteria themselves. It alters the patient's skin. So if the microorganisms are altering, it's in response to changes in the skin of the patient. The drug appears to make the skin less hospitable to acne-causing bacteria."

The scientists studied bacteria sampled from facial skin swabs at 4 time points over the course of the 10-month research study. The samples originated from 17 people whose acne was treated with isotretinoin and, as a contrast, 8 untreated subjects. Of these eight, four had normal skin and 4 had acne. The scientists found that isotretinoin treatment increased the diversity of microbes discovered on the skin. Through DNA sequencing, the scientists also identified 4 kinds of bacteria that bloomed with isotretinoin treatment. None had previously been associated with improved acne.

Isotretinoin also lowered the total number of Propionibacteriumbacteria, even as the treatment increased the variety of the individual types of this bacteria. The 38% of isotretinoin-treated individuals who didn't show this beneficial pattern in the Propionibacterium communities is quite similar to the percentage of isotretinoin-treated individuals in other studies who ended up needing extra rounds of treatment.

The study's findings, according to the researchers, recommend that isotretinoin creates a "bottleneck" that selects for beneficial communities of Propionibacteria and other bacteria that appear to be healthy, developing a skin microbial community that reduces the possibility of the acne returning, even when typical oil production returns to the skin after treatment stops." When you have a bottleneck, you develop an opening for other microbes to relocate and increase in abundance," said Mitreva, the study's senior author and an assistant director of the McDonnell Genome Institute at Washington University School of Medicine. "We see this taking place here. After the treatment, the microbial communitiesshift to a mix of populations that appears to be healthier, and that shift continues months after the treatment."

The researchers said it is very important to understand how isotretinoin works, in an effort to produce new therapies that might be more effective or have less side effects. Given that isotretinoin is known for triggering birth defects, it shouldn't be prescribed to women who are pregnant or attempting to become pregnant. Women of reproductive age who take isotretinoin are prescribed birth control for the exact same factor." Women often will go without treatment for acne throughout their pregnancies since there simply aren't good treatments that are totally safe to use throughout that time," McCoy stated. "They need other options. Our research study recommends there could be a method to offer some type of microbial 'fertilizer' or 'weed killer' on the skin to assist promote the growth of healthy microorganisms. We're carrying out a larger study to look more closely at these questions."

Source: https://scienceblog.com/504939/medication-for-severe-acne-isotretinoin-alters-skin-microbiome/
The lead researchers: https://infectiousdiseases.wustl.edu/faculty-staff/makedonka-mitreva/
See also: https://dermatology.wustl.edu/people/william-h-mccoy-md-phd/