Association of Systemic Antibiotic Treatment of Acne With Skin Microbiota Characteristics.

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PubMed ID: 30758497

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Chien AL, Tsai J, Leung S, Mongodin EF, Nelson AM, Kang S, Garza LA

JAMA Dermatol. Feb 2019. doi: 10.1001/jamadermatol.2018.5221

COMMENT: This pilot study investigated the association of systemic antibiotic treatment with acne severity and skin microbiota. The skin bacterial community of four women who had received a recent diagnosis of acne and were treated minocycline was sequenced using primers targeting the V3-V4 region of the 16S rRNA. Skin samples were collected before starting the treatment, 4 weeks after antibiotic therapy and two time points after discontinuation of treatment.


The aim of the present study was to examine the composition, diversity, and resilience of skin microbiota following antibiotic perturbation in individuals with acne.

Main results

We confirmed the predominance of Cutibacterium species and C. acnes as well as bacterial taxa belonging to phyla Actinobacteria, Firmicutes, and Proteobacteria in skin samples, in accordance with previous studies.

Treatment of acne with minocycline was associated with a 1.4-fold reduction of C. acnes across all patients, with recovery toward baseline C. acnes levels 8 weeks after discontinuation of minocycline therapy.

Staphylococcus epidermidis showed a consistently low relative abundance across all time points, at a level approximately 100-fold lower than that of C. acnes

Twelve genera were identified with relative abundance greater than 0.1% across all samples and with statistically significant changes over time. Among these 12 genera, they noted 4 distinct patterns of change.

Five genera showed decreases in relative abundance on treatment with minocycline: Cutibacterium, Corynebacterium, Prevotella, Lactobacillus and Porphyromonas. Of these only Porphyromonas recovered at week 12 to a level that was not statistically different from baseline.

Seven genera showed increases in relative abundance on treatment with minocycline: Streptococcus, Chryseobacterium, Finegoldia, Pseudomonas, Erwinia, Actinobacillus and Micrococcus. Only the latter 4 genera returned at week 12 to a level that was not statistically different from baseline.

The authors point the limitations of the study among them small sample size and short duration of antibiotic treatment that may have limited the power of the  study to detect changes in acne severity.

Observed changes in inflamed lesion count and α diversity over time did not reach statistical significance. However, we noted distinct and statistically significant changes in α diversity in individual patients.


Antibiotic treatment was associated with changes in the composition and diversity of skin microbiota with variable rates of recovery across individuals. Reductions in the relative abundance of C. acnes associated with systemic antibiotic treatment was accompanied by concurrent growth and suppression of various bacterial populations, with possible clinical implications. Understanding the associations between antibiotics and skin microbiota may help clinicians decrease the likelihood of skin comorbidities related to microbial dysbiosis.


Diana López-Farfán