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According to the American Academy of Dermatology, acne is the most prevalent skin disease in the United States. It affects about 50 million people each year. But it is also one of the most complicated because its causes and effective treatments seem to differ from person to person.
All college students connected to the Internet know that papules, pustules and blackheads begin to form when dead skin cells and oils clog the hair follicles that line our face and upper body. This creates the ideal space for a common microbe, Cutibacterium acnes, dig in. But only a few clogged pores become swollen, red pimples. This happens when our own immune cells rush, causing inflammation. Even for dermatologists, the subtleties of this immune response are still not clean, clear, or under control.
Traditionally, doctors have regarded acne as a chronic skin condition, such as psoriasis, with its characteristic rash, or rosacea, which causes redness and bumps on the face. But in a new article, published Thursday in the newspaper Trends in immunology, a team of Hungarian scientists says that acne appears more like an orthopedic device or a beacon: a "natural and transient inflammatory state", apparently important for the development of the adolescent. Using existing research on animal models, experiments on human skin samples and genetic data, the researchers conclude that it all boils down to age-related changes in the microbiome of the skin.
Most people spend their childhood with spotless skin, but something changes with puberty. More precisely, the sebaceous glands. These microscopic bags, which are attached to the hair follicles, pump the oil to keep the skin lubricated. Although they serve the pinker stretchers more rosy throughout our lives, the glands are particularly aggressive at puberty, when our systems are flooded with androgenic hormones, which stimulate the production of sebum among other functions of transformation.
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The authors argue that these teenage oil spills are lipophilic (literally fat-loving) microorganisms such as C. acnes the fuel they need to dominate their environment. But it's not just any C. acnes which proliferates: Recent genomic evidence indicates that the bacterium exists in many different strains, some of which are beneficial and others more likely to trigger inflammation. Detecting that the microbiome is not upset, the immune system rushes into battle to sting your skin.
"It's actually a very interesting proposition to explain our acne," Gizmodo Suzan Obagi, a dermatologist and cosmetic surgeon at the University of Pittsburgh Medical Center, told Gizmodo. "One of the things we realize more and more is the importance of this balance between the human being and the microbiome."
Those fat teen years do not last forever, of course. The production of sebum naturally decreases with the decrease of puberty. The researchers think that this explains why 85% of teens suffer from acne, but as many as 50% of cases resolve themselves spontaneously. While this may be a physically and psychologically traumatic condition to endure, the paper assumes that acne could be a learning experience for the immune system, which leads to limpid skin as we l? expect from adulthood. Except that … it's not like that always works.
"I do not agree with the transitional element," Adam Friedman, a dermatologist in the George Washington University School of Medicine who was not involved in the new paper, told Gizmodo. "As a practicing dermatologist, the number one patient I see is an adult, not a teenager." Although some people may have the impression that acne apparently subsides overnight, many Patients need treatment or prescription treatment to keep pimples at a distance of 20 to 30 years, and in some cases even in their forties and fifties. "I think a lot of people underestimate acne," Friedman said. "It can have long-term consequences," including scars and discoloration.
Other dermatologists were skeptical about the importance given by the document to the sebaceous glands, possibly to the exclusion of other important pathways. Whitney High, a dermatologist from the University of Colorado who was not associated with the research, told Gizmodo that the document overlooks the crucial role of hormones, which can in turn worsen or weaken the body's health. acne, especially in women. And Friedman noted recent research showing C. acnes The study did not produce short chain fatty acids that disrupt the immune regulation of sebaceous cells. (Andrea Szegedi, the corresponding author on paper, declined to comment on this story.)
"It's a very hot topic," Friedman said. Traditionally, doctors prescribed retinoids, salicylic acid, and systemic antibiotics such as tetracycline to acne patients. In recent years, dermatologists have come to understand that their field is a major contributor to antibiotic resistance, in part because people with acne often used antibiotics for months or even years. But the growing recognition that acne is caused, at least in part, by a disrupted microbiome (and not, as popular myth has it, fatty foods or poor hygiene) means that some doctors are changing course .
Instead of destroying the bad bacteria, Friedman said, they want to replenish what is good. He described modern approaches designed to fight acne by helping the skin microbiome maintain balance, such as probiotics, consisting of living microorganisms that promote the growth of beneficial bacteria and fungi, and prebiotics, derived from compounds present in foods and serving a similar purpose. "These solutions are still in their infancy," Friedman said, but the message is clear: you can teach old skin new tricks.
Even though acne treatments are becoming more sophisticated, the disease escapes scientists' attempts to fully understand it. And for the greatest sorrow of the sick from all over the world, a foolproof remedy does not seem anywhere.
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