Are we finally closing in on an acne cure?

Acne doesn’t discriminate by gender or race, and while it’s most common in adolescents and young adults, it can appear at later ages, especially in women.

While there’s no way at present to prevent acne – and no cure – acne can be treated effectively.

Advances in both medications and approaches to controlling acne have significantly reduced the impact it once had on both skin and self-esteem. The treatment of acne is now becoming more individualised – taking into consideration differences in the way different people respond to the disease.

Dermatologists and skin therapists routinely prescribe topical medications and cosmeceuticals in combination with other modalities to address the multiple causes and effects of acne. There are also advanced ways to treat scarring, including chemical peels, microdermabrasion and laser technologies.

“Over-the-counter products can work in many cases,” says Dr William Huang, assistant professor of dermatology at Wake Forest Baptist Medical Center in the US. “But no matter what the TV ads may say, they take time, usually six to eight weeks. You’re not going to have that overnight here today, gone tomorrow phenomenon. That can be frustrating, especially for teenagers. Acne can cause them a lot of stress and affect their emotional well-being so they want something that works right away, but we don’t have anything like that.”

“Just like with any condition, there isn’t a magic bullet,” Dr Huang cautions. “The treatment depends on the severity of the acne, the type of acne, where it’s located and the patient’s individual preference and motivation for treatment. But these multi-layered approaches that are tailored to the individual patient do work well.”

On the trail of a cure

Treating acne is a multi-billion dollar industry, which includes department store brands and medical-grade cosmeceuticals to light-based devices and prescription medication, usually with the aim to kill the bacteria that causes acne in the first place.

The problem is that killing the bacteria doesn’t work for everyone. A study published online in the Journal of Investigative Dermatology (28 February 2013) found that severity of acne does not necessarily correlate with the amount of P. acnes on the skin. It also turns out there are different strains of the bacterium, some of which may cause more severe cases.

Indeed, killing all of these bacteria might not be the best approach. Dr Jenny Kim, a dermatologist at the University of California – Los Angeles (UCLA), told The Atlantic that while the bacterium is involved, everyone has P. acnes on their skin: “Whether it’s a specific strains of P. acnes, or whether it’s an individual’s host immune response that’s the problem, we’re not certain. But recently, people have begun to think that modulating immune response is a better way forward in terms of treatment. The newer trend is to look at anti-inflammatory agents rather than only focusing on the antimicrobial.”

Following this, in a study published online in the journal Scientific Reports (21 December 2016), researchers have uncovered new information about the causes of acne, which could change the way the skin disorder is treated. In their study, the researchers uncovered evidence that the balance of bacteria on the skin may play a key role in acne development.

 THIS NEW ACNE VACCINE WILL BE THE FIRST VACCINE FOR HUMAN BEAUTY

Study leader Dr Huiying Li at UCLA and his colleagues suggest that acne may not be caused by the presence of a specific strain of bacteria. The bacterium P. acnes is considered a key player in acne development, however it is highly abundant in the pores of individuals with and without acne, which indicates that it is not simply the presence of this bacterium that drives the skin condition.

On comparing the skin microbiomes of individuals with and without acne, the researchers identified some differences in strains of P. acnes. They found that adults without acne possessed P. acnes abundant with genes that are associated with bacterial metabolism. Such genes are believed to be involved in halting the colonisation of harmful bacteria in the skin. However, adults with acne had higher levels of virulence-related genes in P. acnes. These included genes linked to the production of bacterial toxins that promote inflammation and poor skin health. Using the identified differences in P. acnes between the two groups, the team was able to accurately predict the presence of acne.

“This study suggests that the makeup of the bacteria in the follicles can reflect, as well as influence, the skin condition in acne or healthy skin,” says Dr Li. The study sheds light on the underlying mechanisms that drive the development of acne, which could lead to targeted treatments for the common skin condition. Such treatments could include probiotics that target specific strains of bacteria, the team suggests.

“Understanding the bacterial community on the skin is important for the development of personalised treatments in acne. Instead of killing all bacteria, including the beneficial ones, we should focus on shifting the balance toward a healthy microbiota by targeting harmful bacteria or enriching beneficial bacteria,” says study co-author Dr Emma Barnard.

A vaccine for acne is finally in the works

If scientists at the University of San Diego have anything to do with it, it looks like complexion problems could soon be a thing of the past: an acne vaccine is finally in the works. Professor Eric Huang, PhD, the project’s lead researcher, has developed an acne vaccine he said can cure the disease.

“This is the first vaccine for human beauty,” he told NBC 7 in the US. “I think this vaccine has a huge market throughout the whole world.” Dr Huang has been researching the vaccine for five years and said it is now ready to go into large-scale clinical trials. Developing a cure has proven a little difficult however, as doctors needed to figure out how to effectively balance the bacteria that causes these breakouts.

“Acne is caused, in part, by P. acnes bacteria that are with you your whole life — and we couldn’t create a vaccine for the bacteria because, in some ways, P. acnes are good for you,” said Dr Huang, in an interview with Allure. “But we found an antibody to a toxic protein that P. acnes bacteria secrete on skin — the protein is associated with the inflammation that leads to acne.”

He explains that an overgrowth of P. acnes bacteria inside an acne lesion can cause inflammation when the bacterium releases a toxin called Christie-Atkins-Munch-Peterson (CAMP) factor, but because of antigen masking, the human body cannot neutralise the toxin by itself. In essence, the vaccine can neutralise the CAMP factor, working to block the acne-causing effects of the bacteria without completely eradicating it.

The vaccine has been tested on skin biopsies collected from acne patients, and early results have been promising. The next stage will be for researchers to trial the vaccine
on patients. “The first phase of those trials, which could take one to two years, will be underway soon,” said Dr Huang. Acne sufferers rejoice – we are finally on the cusp of a cure!