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PROPIONIBACTERIUM ACNES AND THE SKIN

DISEASE OF ACNE VULGARIS

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Review Propionibacterium acnes and the skin disease of acne vulgaris

PROPIONIBACTERIUM ACNES AND THE SKIN

DISEASE OF ACNE VULGARIS
PROPIONIBACTERIUM ACNES I IMPLICAREA LUI
N ACNEEA VULGAR

Elham BEHZADI, Payam BEHZADI, Cristiana VOICU2

1
Department of Microbiology, College of Basic Sciences, Shahr-e-Qods Branch, Islamic Azad University, Tehran, Iran
2
Dermatology Department, Polisano Clinic, Bucharest, Romania
Corresponding author:
Dr. Payam BEHZADI, Ph.D in Molecular Biology,
Tehran, Fath Highway, Shahr-e-Qods, The end of Shahid Kalhor Blvd, Post Box: 37541- 374,
Tel: +98-912-4799734.
E-mail: behzadipayam@yahoo.com

Conflict of interest: The authors do not

have any conflict of interest to declare.
Open Access Article

Abstract

The human skin encompasses a vast variety of microorganisms

Keywords: which construct the structure of skin microflora. Bacteria and
yeasts may be the pioneers of the human skin normal flora.
Propionibacterium The anatomical situations and physicochemical conditions de-
acnes, Acne vulgaris, termine the demography of the microbial populations. Among
skin colonization. different types of microbial populations, Propionibacterium
acnes is the predominant member in the skin areas of back,
face and chest. Although this bacterium is part of the normal
flora, Propionibacterium acnes contributes to the disease of
acne vulgaris. By the progression of scientific disciplines such
as Microbiology, Genetics, and Molecular Biology, it is going
to be clear that some strains of Propionibacterium acnes are
useful and good bacteria and some strains are harmful and
bad bacteria. Therefore, in this review, the authors have a look
on different characteristics of P.acnes and the related skin dis-
ease of acne vulgaris.

Cite this article:

Elham BEHZADI , Payam
BEHZADI, Cristiana
VOICU.Propionibacte-
rium acnes and the skin
disease of acne vulgaris.
RoJCED 2016;
3(2):117 - 120

June 2016 117

Review Propionibacterium acnes and the skin disease of acne vulgaris

Rezumat
Cuvinte-cheie:
Propionibacterium
acnes, acnee vulgar,
colonizare cutanat.
Pielea gzduiete o varietate de microorganisme care particip la
alctuirea microflorei cutanate. Bacteriile i fungii par a fi pionierii florei cu-
tanate normale. Particularitile anatomice i diferite condiii fizico-chimice
influeneaz demografia populaiilor microbiene. n cadrul diferitelor tipuri
de populaii microbiene, Propionibacterium Acnes se gsete predomi-
nant n pielea de la nivelul feei i al toracelui antero-posterior. Dei aceast
bacterie face parte din flora cutanat normal, Propionibacterium Acnes
este de asemenea responsabil de apariia acneei. Dezvoltarea unor disci-
pline tiinifice precum Microbiologia, Genetica i Biologia Molecular, va
concluziona dac anumite tulpini de Propionibacterium Acnes sunt utile
i benefice iar altele sunt duntoare. Aadar, n revizuirea de fa, auto-
rii analizeaz diferite caracteristici ale P. Acnes i implicarea ei n acneea
vulgar.

Introduction The human skin and related microbiota

Propionibacterium acnes, or former Corynebacte-
rium parvum, is an important bacterial agent which
acts as a multifunctional microorganism. This bac-
terium is seen in different parts of the human body,
from the conjunctivae, oral cavity, and nares to in-
testinal and respiratory tracts. The biochemical
properties of P.acnes are related to the bacterial
functions and activities. This bacterium is a slow
growing Gram +ive, anaerobic and microaerophil-
ic bacillus which is able to produce propionic acid
as a fermentative microbial product. P.acnes popu-
lations cover 50% of the human skin normal flora;
however, the number of populations differs in dif-
ferent parts of the body. It ranges from <10 cells/
cm2 on the nose to 107 cells/cm2 on the human
facial skin. On the other hand, this bacterium may
act as a skin pathogenic microorganism, which
may lead to different types of skin diseases like
acne vulgaris. According to previous studies, there
are many factors, comprising nourishment pro-
gram and skin hygiene that determine the number
of bacterial populations of P.acnes as an opportu-
nistic microbial agent causing acne vulgaris. Dekio
et. al. have indicated that P.acnes encompasses
several strains and the highest strain diversity has
been observed on the facial skin. Among different
bacterial strains of P.acnes, ST6 has a high tenden-
cy to dryness and rigid conditions(1-7).
P.acnes is an interesting opportunistic bacterium
which plays a significant role in both health and
infection of human hosts. In addition to acne vul-
garis, the ubiquitous bacterial agent of P.acnes
has a bold contribution to different types of infec-
tions associated with indwelling medical devices
and prostheses. Despite the vast activity regarding
infectious diseases, the presence of P.acnes as an
important skin microbiota prevents colonization
of dangerous pathogenic microorganisms. In this
review, the authors have a look on different char-
acteristics of P.acnes and the related skin disease
of acne vulgaris(7-9).
Skin is recognized as the largest outer organ in
the human body which protects the inner system
from outsiders and foreigners. Indeed, skin acts as
the first natural barrier against microorganisms as
a part of the innate immune system. Human skin
involves a wide range of microflora, significantly
including Acinetobacter, Candida, Corynebacte-
rium, Malassezia, Micrococcus, Propionibacterium,
Saccharomyces, Staphylococcus(10-15).
Among aforementioned microorganisms, the popu-
lations of Propionibacterium are predominant bac-
terial microorganisms on sebum rich zones (such as
chest, back, and head) and pilosebaceous follicles. In
accordance with several investigations, there is a con-
siderable variety among Propionibacterium species
which comprises P.avidium, P.acnes, P.lymphophilum,
P.granulosum and P.propionicum(12,15,16).
Furthermore, the physicochemical conditions of
the skin including glands (their size, number and
functions), follicles (their size, number and func-
tions), the density of secreted discharges like
sweat, sebum, antimicrobial secretions such as
defensins and dermicidin, nutrition, temperature,
oxygen, pH, microbial products and their antago-
nistic and synergistic effects determine the residue
of cutaneous normal flora populations. The ability
of enzyme secretions in microorganisms is another
factor in their colonization of the skin, because the
presence of microbial extracellular enzymes in the
human skin makes a wide range of nutrition acces-
sible for microorganisms (12,17).
Acne Vulgaris
Acne vulgaris a chronic skin condition, originat-
ing from hair follicles and the related sebaceous
glands, classified as inflammatory/non-inflamma-
tory or alternation of both. However, minor popu-
lations of patients have severe forms of acne vul-
garis. There are many factors which may lead to the
occurrence of acne vulgaris. One of the most im-

118 R O M A N I A N J O U R N A L o f C L I N I CA L a n d E X P E R I M E N TA L D E R M ATO LO GY

portant factors regarding the appearance of acne
vulgaris is genetic predisposition, accompanied
by deep hormonal changes. The prevalence of
acne vulgaris in Dark skinned people, the Mediter-
ranean region people, the Caspian Sea region and
the Persian Gulf region people is higher than other
parts of the world. Moreover, young boys (male
teenagers) are more frequently affected by severe,
nodulo-cystic forms of acne, while in women the
disease is lasting longer, reaching adulthood or, in
some cases, appears for the first time into the 3rd
or 4th decade of life. Acne pathology comprises 4
steps including blockage of the follicle via abnor-
mal keratinization of follicular units, overwhelmed
sebum production and storage, hyperactivity of
resident normal flora populations of P.acnes and
the appearance of inflammation(18-23).
In patients with acne vulgaris, comedones and
swollen, erythematous, painful papules, pustules
and nodules are seen mostly on facial skin area,
back and chest (particularly on the upper chest
zone). Comedones are made by abnormal secre-
tion of lipids resulting in follicular keratinization. Si-
multaneously, the resident populations of P.acnes
begin to proliferate within the accumulated sebum
and keratinized follicle. A closed whitehead com-
edone consists of dead cell debris, P.acnes and the
related bacterial secretions (such as hyaluronidase,
neuraminidase, protease etc.), and sebum. These
materials provide the proper environment for the
comedones to become inflamed and breached.
Among these compounds, the bacterial extracellu-
lar enzymes secreted by P.acnes cells raises up the
rate of breakage of the closed comedones. The
activity and proliferation of P.acnes bacterial cells
stimulate the innate immune system with different
types of chemokines and cytokines(1,24-26).
Genomics and Biofilm formation
of Propionibacterium acnes
The complete genome of some strains belonging
to P.acnes has been determined and published.
The study of complete genome sequences
shows a diversity of virulence factors such as ad-
hesins, inflammatory factors and weakening host
cell factors (in particular, extracellular enzymes
like protease, lipase, hydrolase etc.). The major
differences between bacterial strains of P.acnes
are recognized in island-like regions (ILRs) which
play a key role in the expression of virulence fac-
tor genes(27-29).
The diphtheroid-like bacterium of P.acnes has a
predominant ability to form stable biofilms. This
characteristic helps P.acnes colonies to reside on
hosts skin surface, which has a protective prop-
erty for the host. Simultaneously, the property of
biofilm formation can be recognized as an im-
portant virulence factor for pathogenic bacte-
rial strains. So, the ability of biofilm formation in
P.acnes can be considered beneficial for useful
strains and harmful for pathogenic strains. The
biofilm structure is composed of bacterial poly-
Elham BEHZADI , Payam BEHZADI, Cristiana VOICU
saccharides which embeds the bacterial cells of
P.acnes within itself. Indeed, the polysaccharide
acts as a biocement. The main characteristic of bio-
film is to prevent the penetration of outsider mi-
croorganisms, immune cells, and antibiotics. Thus,
the biofilm structures of P.acnes strains relating to
normal flora populations are good and the biofims
of invasive and infectious strains of P.acnes may be
life-threatening and deathful. A considerable fac-
tor which helps P.acnes to dominate other microor-
ganisms which reside on the surface of human skin
is the ability of secretion of extracellular enzyme
of lipase. That is why, the bacterium of P.acnes are
isolated from the fatty portion of the skin like face,
back, and chest(1,30-33).
Propionibacterium acnes and hosts immune
system
The immunologic investigations have revealed
that opportunistic pathogenic strains of P.acnes
trigger the pattern recognition receptor (PRR)
molecules within the host immune system. The
PRRs have different types of members like Toll-
Like Receptors (TLRs). Secretion of extracellular
enzymes by P.acnes makes some injuries in host
skin tissues. The damaged skin tissue stimulates
TLRs (TLR-2 and TLR-4) on keratinocytes which
may lead to secretion of chemokines and cyto-
kines comprising Interleukin (IL)-1a, IL-8, and
Tumor Necrosis Factor (TNF)-. TLR-2 has a key
role in association with inflammation of comedo-
nes on the host skin (1, 9, 34-36).
Treatment
Treatment must address all the factors implicated
in acne pathogenesis and has to be tailored to
disease severity. The simultaneous use of topi-
cal retinoids and antibiotics is the best choice for
a definite treatment of acne vulgaris caused by
P.acnes. The use of antibiotics, especially in the
form of oral consumption, is recommended for
moderate to severe acne vulgaris. However, there
are several reports regarding drug resistant strains
against metronidazole and some members of ami-
noglycosides. The use of benzoyl peroxide is rec-
ommended for all forms of acne vulgaris. The use
of retinoids in the form of oral consumption is the
best choice for severe forms of acne vulgaris. Fur-
thermore, hormonal therapy may be used as the
second choice when hormonal disturbances or
polycystic ovary syndrome have been document-
ed(19,20,37,38).
Conclusion
Acne vulgaris is a multifactorial condition. Ge-
netic predisposition, hormonal changes, race,
geographic situation, sex and bacterial strains
have direct effects on the occurrence of acne
vulgaris in patients. So, no single factor may be
able to arise the disease of acne vulgaris.
The role of P.acnes in acne pathogenesis has
June 2016 119
Review
been a matter of dispute over the years; there-
fore future studies are mandatory in order to
conclude this subject. Recent data suggests that
this interesting Gram positive bacillus has the
ability to act both as a skin commensal with pro-
tective action in people without acne and as a skin
pathogen, by promoting follicular inflammation
and hyperkeratinization in patients with acne. Its
ability to form stable biofilms can be regarded as a
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