Virulent Acne Biofilms Offer Insight into Novel Therapeutic Options

Abstract

Acne vulgaris is a disease of the pilosebaceous unit that may manifest as either noninflammatory or inflammatory skin lesions. The microcomedone theory suggests that the first step in the pathogenesis of acne vulgaris is the noninflammatory comedone. The comedone is a collection of keratin and sebum that is trapped within the pilosebaceous unit due to hyperproliferation of keratinocytes in the follicular lining. The biofilm produced by P. acnes bacteria promotes the formation of a comedone by acting as a biological glue that prevents expulsion of the hyperkeratotic plug. In addition to its adhesive properties, the biofilm has virulence factors contributing to the pathogenicity of P. acnes in acne vulgaris. With further investigation and a better understanding of the P. acnes biofilm, new therapeutic options for acne vulgaris can be made available. By targeting the P. acnes biofilm, treatment can be made more effective and precise, without the concern of side effects seen in currently available acne medications.