https://www.immpressmagazine.com/the-immunology-of-acne/#:~:text=The%20major%20morphological%20changes%20associated,activate%20in%20response%20to%20P.
A few thoughts, one its not the acne bacteria itself but the immune response to this bacteria that generates acne or pimples.
“In individuals with acne, elevated sebum production drives the proliferation of this bacteria, inducing an inflammatory immune response that produces the morphological pimple.”
Second, the author has a couple of thoughts on possible negative consequence of the wrong type of treatment.
“While the mechanisms driving the initial overgrowth of P. acnes are well characterized, the role of the immune response in supporting or exacerbating acne is unclear. TLR2 has been suggested to play an important role in acne pathogenesis by mediating inflammatory processes and accordingly, TLR2 antagonists such as isotretinoin have shown clinical efficacy. Immunotherapy involving immunization with heatkilled P. acnes or virulence factor-specific antibodies has also shown efficacy in mouse models, underscoring the importance of understanding the mechanisms by which P. acnes survives and subverts the immune response. To this end, genome sequencing of P. acnes has revealed several virulence factors (lipases, pore-forming factors, etc.) that might serve as candidate antibody targets for systematic investigation.”
“However, given that P. acnes can exist in a commensal manner, these targeted immune therapies could have their own adverse effects. Furthermore, it remains to be determined whether the immune response in acne is productive since multiple post-acne conditions such as post-inflammatory hyperpigmentation and scarring are linked to immune-driven dysfunction. Perhaps a different change in treatment paradigm is necessary: one that focuses on dietary interventions to reduce IGF-1 levels and attenuate excess sebum production. Such an approach is supported by the complete absence of acne seen in non-westernized tribal populations, presumably due to their low glycemic, neolithic diets. Thus, acne may be among the many other conditions that reflect our physiological inertia to the rapidly changing nutritional environment around us.”
My two thoughts are this, p.acnes as a protectant or p.acnes as something that needs to be regulated by the immune system?
In the case of Accutane, two similar scenarios,
Did Accutane eradicate p.acnes or just stop the immune response to this bacteria?
adding to this,
A significant amount of research in the past 10 to 15 years has shown how part of the immune system, called the innate immune system (the first responder that signals the alarm if there are any infectious invaders), reacts inappropriately to P. acnes and calls in the immune troops. Elements of this immune system (called Toll-like receptors and inflammasomes) orchestrate the process, and it is therefore no surprise to dermatologists that while some of our current treatments work, they also inhibit these alarm systems.