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INVESTIGATIVE REPORT
Patients with Acne Vulgaris Have a Distinct Gut Microbiota in
Comparison with Healthy Controls
Yongqiong DENG 1# , Hong WANG 1# , Jiyuan ZHOU 3 , Yunzhu MOU 4 , Guiqiang WANG 2 and Xia XIONG 1
1
Department of Dermatology & STD, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 2 Department of Infectious
Disease, Peking University First Hospital, Beijing, 3 Biomedical Research Institute, Shenzhen Peking University, The Hong Kong University of
Science and Technology Medical Center, Shenzhen, Guangdong Province, 4 Department of Dermatology & STD, Affiliated Hospital of North
Sichuan Medical College, Nanchong, Sichuan, China
#
These authors contributed equally to this article.
Acne vulgaris has been postulated to have a gastroin-
testinal mechanism; however, little is known about gut
microbiota dysfunction in this condition. The aim of
this cross-sectional study was to investigate whether
the gut microbiota is altered in acne. Faecal bacterial
diversity was analysed in 43 patients with acne and
43 controls, using hypervariable tag sequencing of
the V3–V4 region of the 16S rDNA gene. Distinct diffe-
rences were found in microbial diversity between pa-
tients with acne and controls (Shannon diversity index
(p = 0.009) and Simpson diversity index (p = 0.01)). At
the phylum level, the abundance of Firmicutes was lo-
wer in the patient group, but that of Bacteroidiain was
higher. The most significantly depleted taxa in acne
were Clostridia, Clostridiales, Lachnospiraceae and
Ruminococcaceae genera, which are potentially bene-
ficial. In conclusion, patients with acne vulgaris have
gut microbial dysbiosis; further study is needed to un-
derstand its role in the pathogenesis of acne.
Key words: acne vulgaris; gut microbiota; bacterial diversity.
Accepted May 9, 2018; Epub ahead of print May 14, 2018
Acta Derm Venereol 2018; 98: 783–790.
Corr: Guiqiang Wang, Department of Infectious Disease, Peking Univer-
sity First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, China.
E-mail: [email protected]; and Xia Xiong, Department of Dermato-
logy & STD, the Affiliated Hospital of Southwest Medical University, No. 25
Taiping Street, Luzhou, Sichuan, China. E-mail: [email protected]
A
cne vulgaris is a chronic inflammatory skin disease
of the pilosebaceous units that is e stimated to af-
fect up to 80–90% of adolescent patients, particularly
in developed nations (1). In general, the pathogenesis
of acne is characterized by increased production of se-
bum, inflammatory mediators in the skin, and follicular
hyperkeratinisation of pilosebaceous ducts. The role of
Propionibacterium acnes is not clear, as this organism
is ubiquitous in healthy adult human skin. However, an
altered phenotype of P. acnes in acne lesions may be
more associated with the disease and may also be pro-
inflammatory (2, 3). Although genetic predisposition
can strongly influence the risk of developing acne, the
role of environmental factors, especially the “Western
style” diet, in the pathogenesis of acne has been sug-
gested (4, 5). The “Western style” diet includes milk,
other dairy products, refined carbohydrates, chocolate,
SIGNIFICANCE
This study presents the difference of gut microbes between
acne vulgaris patients and healthy controls. Comparing
with healthy controls, acne patients show the decreased
diversity of gut microbiota and the increased ratio of Bac-
teroidetes to Firmicutes which has been reported to be the
enterotype of the Western diet. These data validate the
role of western diet in promoting the development of acne
vulgaris and suggest the diet and probiotic-based therapy
in preventing and treating acne vulgaris.
and saturated fats, which contribute to the formation of
acne by activating nutrient-derived metabolic signals (6,
7). Dietary supplementation with omega-3 fatty acids
has been reported to help decrease lesions in patients
with mild to moderate acne (8). The ratio of omega-6 to
omega-3 fatty acids is higher in “Western style” than in
non-Western diets (9).
Accumulating evidence indicates that the gut mi-
crobiota associated with the “Western style” diet play
a significant role in the development of a number of
disease states, such as immune, metabolic, and even
skin, diseases (10–12). High-fat diets have been repor-
ted to reduce the levels of gut microbes and increase
the concentration of lipopolysaccharides (LPS), which
contribute to the development of systemic inflammation
by impairing colonic epithelial integrity and barrier func
tion, decreasing mucus layer thickness and increasing
the secretion of pro-inflammatory cytokines (13–15).
However, there is no direct evidence that imbalance of
gut microbiota contributes to the pathogenesis of acne
vulgaris.
It can be postulated that acne vulgaris features a
gastrointestinal mechanism based on the theory of
microbiota-gut-brain axis (16). The latest research has
shown that communication between the gut and brain
plays a critical role in maintaining optimal health,
and that changes in gut microbiota may affect central
nervous system function and neuroendocrine respon-
ses, such as the hypothalamus pituitary adrenal axis
(HAP) (16–18). HAP modulates most of a number of
pathways and hormones implicated in the pathogenesis
of acne, such as androgens, insulin-like growth factor,
corticotrophin-releasing hormone, ectopeptidases, adre-
This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2018 Acta Dermato-Venereologica.
doi: 10.2340/00015555-2968
Acta Derm Venereol 2018; 98: 783–790