A new key player in the origin of acne is discovered

If pimples originate from oily skin, why doesn’t a thorough wash stop them from coming out? A recent study provides an answer and could suggest a new line of defense.

Whiteheads, or blackheads, harbor tiny and very limited bacterial infections. The most common culprit is bacteria Cutibacterium acnes, which lives without causing problems between skin cells until the skin’s sebum increases and, given the abundance of nutrients that this generates, it multiplies uncontrollably. What we think of as acne — the pustules, redness and swelling — is the result of a battle between the immune system and proliferating bacteria, explains dermatologist Richard Gallo of the University of California, San Diego, who directed the new study. “In most cases, it’s not that our skin is dirty or we don’t wash our faces enough. The problem lies in the way our immune system deals with the bacteria that are supposed to be there”, he clarifies.

If we imagine that the immune system and bacteria are two football teams, acne is the battered grass that remains at the end of the game. The new study points to a hitherto unknown player on the immune team who is especially disruptive. Gallo and his collaborators reveal in Science Translational Medicine that a type of structural cell called a fibroblast (not normally considered an immune cell) contributes to the disaster. In the course of experiments with mice and human skin samples, they have discovered that C. acnes promotes the transformation of fibroblasts into adipocytes that secrete an antimicrobial substance, in addition to proinflammatory proteins. They also found that retinoids, a class of commonly used potent anti-acne medications, work in part by preventing this transformation of fibroblasts and by releasing irritating proteins.

Jonette Keri, a clinical dermatologist at the University of Miami Miller School of Medicine, who was not involved in the study, calls the discovery an interesting new way to look at acne. Retinoids can cause side effects, so she says that finding a more specific way to stop fibroblasts from transforming would be a fantastic treatment.

maddie bender

Reference: “Antimicrobial production by perifollicular dermal preadipocytes is essential to the pathophysiology of acne”; Alan M. O’Neill et al. in Science Translational Medicine, vol. 14, February 2022.

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