A vaccine for acne? It sounds a bit like science fiction, but some investigators are looking at the potential for taking a novel approach to acne. To be clear, acne is not a bacterial infection, however, new research published in the Journal of Investigative Dermatology suggests that antibodies that are created in response to P. Acnes may help reduce inflammation in acne lesions.
Acne is the most common skin condition, affecting the vast majority of us during our teens to our 30s.1 Acne is not a life-threatening condition. Still, we’ve learned through decades of research just how high the costs are in terms of psychosocial burden on the patient. This is particularly a concern as acne affects adolescents, a period of time where physical, emotional, and social challenges are heightened.
Over the last several decades, acne treatment has improved in leaps and bounds. Yet, there is still plenty of room left for acne treatment to grow – certainly true from the perspective of patients! Acne treatment, even when successful, requires patience – unlike treating a common bacterial infection, treatment takes months, not days. Sometimes, the side effects can also be problematic: Common side effects of treatment include dry and irritated skin and initial worsening of acne. Stronger treatments like Isotretinoin can also have the potential to cause more serious side-effects like depression, suicidal ideation, and increased rate of birth defects can also come into play.
What’s Exciting about this Study?
Vaccines are designed to provide acquired immunity to a particular disease. They are almost always directed at invasive bacteria; this would be the first of its kind to target bacteria that is already a part of the human skin flora. P. Acnes (Propionibacterium acnes)2 is a largely commensal bacteria that live on human skin and is considered part of healthy adult human flora. The problem arises when this bacteria feeds off sebum and multiply rapidly under certain conditions. The usual trigger for this is blocked pores – which causes this bacteria to multiply and then secrete enzymes and metabolic byproducts that can trigger inflammation, causing acne.
This approach, if successful, may provide a new type of treatment that may provide treatment without the unwanted side-effects associated with current topical or oral treatment for acne. Known as CAMP Factor,3 it has been well established that acne bacteria can induce inflammation. This research delved into whether applying monoclonal antibodies can have an inhibiting effect on this inflammatory response, using mice, as well as ex vivo tests on human skin cells.
This study presents an interesting and fresh avenue to acne treatment. Immunotherapy is being looked at very closely in other treatments, such as cancer treatment, and is making headlines in the medical community. Acne immunotherapy may show similar signs of promise, but a lot of work remains.
The first challenge is to understand what happens in a live environment. P. Acnes lives on the skin along with various other microbiota in a system. Acne immunotherapies that target existing commensal bacteria need to be cautious about disturbing the microbiome environment. Like natural systems, affecting only one part in a targeted manner can be challenging.4 Disrupting the environment may have unintended consequences on other commensal bacteria that share the same habitat as P. Acnes. Other questions that remain include whether these targeted treatments will have a positive effect on different subtypes of acne or not. Nonetheless, this study may be an important part of opening the door to a new type of therapy for acne.
First, acne is NOT a bacterial infection, so the “vaccine” should not be viewed as a type of “cure” for acne.5 The new approach to treating acne by targeting the CAMP factor by adding in antibodies might reduce the inflammatory effects that lead to acne. While the approach is, in fact, vaccine-like, it should not be seen as the definitive cure to acne. It does, however, offer some potential therapeutic gains in the future, not just for acne but also extending into other P. Acnes associated diseases such as sepsis, surgery infections, and even prostate cancer.
1The exact count varies from 75 to the high 90 percentiles depending on who and how people are sampled and what counts as an acne lesion. Still, most of us living in the West are not exempt from suffering from acne in some form.
2This bacteria has recently been reclassified to Cutibacterium Acnes (C. Acnes) as genomic studies have shown them to be distinct from similar ones that reside in the gut and other areas. The term P. Acnes will likely be used for some time, given its familiarity in the field.
3CAMP Factor (Christie – Atkins – Munch-Petersen Factor): Toxins secreted induce inflammation which triggers the main symptoms of acne.
4People frequently underestimate the complexity of natural systems and suffer from various unintended consequences.
5 Vaccines are often so effective at controlling infections that we often associate them with “cures,” but this isn’t accurate.