How Isotretinoin Alters the Skin Microbiome in Acne Treatment

Managing acne can be challenging, especially when topical treatments provide only temporary relief. For individuals with severe or persistent acne, medications like isotretinoin may be considered as an option. Although the precise mechanisms of isotretinoin are not completely understood, it is thought to work by reducing oil production in the sebaceous glands and supporting clearer skin. Recent research suggests that isotretinoin may have additional effects on the skin, particularly by influencing its microbiome.

In 2019, a pilot observational prospective Study published in the Journal of Investigative Dermatology revealed an unexpected effect of isotretinoin: it alters the skin’s microbiome. The microbiome consists of the community of bacteria that lives on the skin’s surface. The health and balance of the microbiome play a central role in the incidence of acne and other dermatologic issues. Recognizing these medication’s positive effects on the microbiome implores the industry to design future acne treatments to nurture healthy skin bacteria, offering a more targeted and potentially safer approach.

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About The Study

The study aimed to explore how isotretinoin may affect the skin beyond its role in reducing oil production, with a particular focus on its potential to influence the skin's microbiome. Researchers hypothesized that changes in the composition and diversity of skin bacteria could be a factor in the drug's long-term effectiveness in treating acne.

To test this, the study was conducted with 17 patients with moderate to severe acne and undergoing isotretinoin treatment. Two control groups were included for comparison: one with untreated acne patients and another with individuals who had clear skin. Including these control groups helped isolate the effects of isotretinoin from natural variations in the skin's microbiome.

The study lasted ten months, during which skin samples were taken at four intervals: before treatment, during treatment at two and five months, and five months after treatment ended. This timeline allowed researchers to track immediate and longer-term changes in the skin's bacterial communities.

The researchers analyzed the skin samples using advanced DNA sequencing, which provided a comprehensive view of the bacterial composition at each stage of treatment. This method enabled the researchers to track how isotretinoin impacted both acne-causing bacteria and other bacterial species living on the skin.

The Findings of the Study

The study suggested that isotretinoin may increase the diversity of bacteria on the skin, which is often linked to healthier skin. In addition, the number of Cutibacterium acnes, the bacteria commonly associated with acne, appeared to decrease during treatment.

Four specific bacterial species, Rothia, Flavobacterium, Enterobacter, and Micrococcus, showed a marked rise in abundance during the treatment period. These bacteria, typically associated with healthier skin, thrived as C. acnes diminished, creating a more balanced bacterial environment.

Interestingly, these bacterial species appeared to remain on the skin after isotretinoin treatment ended, suggesting that the medication might lead to lasting changes in the skin's microbial community. This change persisted regardless of whether oil production had returned to normal levels, suggesting that isotretinoin's impact on the microbiome was not solely tied to its oil-reducing properties.

The long-term presence of these healthier bacteria may explain why isotretinoin leads to sustained acne remission in many patients. The treatment appears to create a more favorable environment for healthy bacterial growth, which could be key to maintaining clearer skin after the treatment ends.

Significance of the Findings

While isotretinoin's mechanism of action was thought to focus primarily on inhibiting sebaceous gland function, this study suggests that its effects may also include altering the skin's bacterial environment, which could play a role in long-term acne management. It reshapes the microbiome, allowing beneficial bacteria to thrive and outcompete harmful acne-causing bacteria like Cutibacterium acnes.

This research provides new insight into how isotretinoin may work, suggesting that its benefits could be linked to promoting a more balanced bacterial environment on the skin. Therefore, its use is more significant to overall dermatologic health than was previously understood. Furthermore, this understanding opens up possibilities for acne treatments that target the microbiome directly instead of focusing solely on oil reduction.

For individuals who can't take isotretinoin due to its risks, like pregnant women, these findings open up possibilities for developing new acne treatments that might replicate isotretinoin's microbiome-altering effects, potentially offering alternatives with fewer side effects.

The findings also invite research into future treatments tailored to individual microbiome profiles, offering more personalized and effective therapies. Focusing on microbiome-based treatments could lead to safer, longer-lasting solutions for more acne sufferers.

Limitations of the Study

The study's small sample size of 17 participants limits its applicability to broader populations. Larger, more diverse studies would be needed to further explore the results and how factors such as age, gender, and skin type might influence the bacterial response to isotretinoin.

The study's 10-month follow-up period is also a limitation, as it is unclear how long the microbiome changes persist. More extended studies are needed to determine whether these shifts offer lasting protection against acne recurrence once oil production normalizes.

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Key Takeaways

• In addition to its role in reducing sebaceous gland function, isotretinoin may also influence the skin's microbiome by increasing bacterial diversity, which could support clearer skin and help reduce the risk of acne recurrence.

• This discovery paves the way for the development of innovative acne treatments that focus on enhancing the skin's bacterial balance. These treatments offer potentially safer alternatives to traditional medications with fewer side effects.

• While the findings are promising, larger and longer-term studies are essential to fully understand the durability of these microbiome changes and their potential to shape future acne therapies.