Acne vulgaris: the skin microbiome, antibiotics and whether natural products could be considered a suitable alternative treatment?

Abstract

Acne vulgaris is a common, chronic inflammatory skin disease manifested as inflammatory and non-inflammatory lesions typically associated with Cutibacterium acnes. However, its pathogenesis is not fully understood nor is the complexity of the skin microbiome and how it contributes to the development of acne. Whilst acne is not a typical bacterial infection, antibiotics have been the mainstay of treatment for over 50 years. Now, with the development of multi-drug resistant organisms and the emergence of resistant C. acnes strains; the question is are antibiotics still an appropriate treatment method or could natural products provide a suitable alternative? Research into alternative treatments is a growing field due to the increase in resistant organisms, there is a multitude of research into natural products due to their antimicrobial potential and the multiple mechanisms of action. Melaleuca alternifolia is a key natural product of interest in the treatment of acne due to its documented use throughout history and its prevalence in over the counter treatments. Green Tea is a more recent natural product of interest due to its composition of polyphenols, which give rise to both antimicrobial and anti-inflammatory properties. However, research also suggests that a synergistic approach of natural products may be the way forward.