Acne, the Skin Microbiome, and Antibiotic Treatment

Am J Clin Dermatol. 2019 Jun;20(3):335-344. doi: 10.1007/s40257-018-00417-3.


Acne vulgaris is a chronic skin disorder involving hair follicles and sebaceous glands. Multiple factors contribute to the disease, including skin microbes. The skin microbiome in the follicle is composed of a diverse group of microorganisms. Among them, Propionibacterium acnes and Malassezia spp. have been linked to acne development through their influence on sebum secretion, comedone formation, and inflammatory response. Antibiotics targeting P. acnes have been the mainstay in acne treatment for the past four decades. Among them, macrolides, clindamycin, and tetracyclines are the most widely prescribed. As antibiotic resistance becomes an increasing concern in clinical practice, understanding the skin microbiome associated with acne and the effects of antibiotic use on the skin commensals is highly relevant and critical to clinicians. In this review, we summarize recent studies of the composition and dynamics of the skin microbiome in acne and the effects of antibiotic treatment on skin microbes.

Publication types

  • Review

MeSH terms

  • Acne Vulgaris / drug therapy*
  • Acne Vulgaris / immunology
  • Acne Vulgaris / microbiology
  • Anti-Bacterial Agents / pharmacology*
  • Anti-Bacterial Agents / therapeutic use
  • Drug Resistance, Bacterial / drug effects*
  • Hair Follicle / immunology
  • Hair Follicle / microbiology
  • Humans
  • Malassezia / isolation & purification
  • Malassezia / physiology
  • Microbiota / drug effects*
  • Microbiota / immunology
  • Propionibacterium acnes / isolation & purification
  • Propionibacterium acnes / physiology
  • Sebaceous Glands / immunology
  • Sebaceous Glands / microbiology
  • Symbiosis / drug effects
  • Treatment Outcome


  • Anti-Bacterial Agents