The use of antimicrobial peptides against C. acnes is under investigation as a treatment for acne to overcoming antibiotic resistance. In 2007, the first genome sequencing of a C. acnes bacteriophage (PA6) was reported. The authors proposed applying this research toward development of bacteriophage therapy as an acne treatment in order to overcome the problems associated with long-term antibiotic therapy such as bacterial resistance. Oral and topical probiotics are also being evaluated as treatments for acne. Probiotics have been hypothesized to have therapeutic effects for those affected by acne due to their ability to decrease skin inflammation and improve skin moisture by increasing the skin's ceramide content. As of 2014, studies examining the effects of probiotics on acne in humans were limited.
Comedones associated with acne vulgaris are usually easy to clear using OTC products, but papules and pustules are a little tougher to treat. Since they arise from trapped, infected pores, the first step in their treatment is to remove the inflammation and reduce the swelling so the pore can heal and breathe. Nodules are one of the few acne conditions that actually demand treatment, as some risk the potential of becoming cancerous. Medical treatment with traditional antibiotic therapy will relieve the symptoms of your acne nodule and gradually decrease its size.
C. acnes also provokes skin inflammation by altering the fatty composition of oily sebum. Oxidation of the lipid squalene by C. acnes is of particular importance. Squalene oxidation activates NF-κB (a protein complex) and consequently increases IL-1α levels. Additionally, squalene oxidation leads to increased activity of the 5-lipoxygenase enzyme responsible for conversion of arachidonic acid to leukotriene B4 (LTB4). LTB4 promotes skin inflammation by acting on the peroxisome proliferator-activated receptor alpha (PPARα) protein. PPARα increases activity of activator protein 1 (AP-1) and NF-κB, thereby leading to the recruitment of inflammatory T cells. The inflammatory properties of C. acnes can be further explained by the bacterium's ability to convert sebum triglycerides to pro-inflammatory free fatty acids via secretion of the enzyme lipase. These free fatty acids spur production of cathelicidin, HBD1, and HBD2, thus leading to further inflammation.
Use a toner after cleansing. After you wash your face, exfoliate, or apply a face mask, apply a toner to the entirety of your face. Toners work to tighten pores making it less likely that dirt and oil will become trapped in them. Buy acne toners at a local drugstore, or use witch hazel or apple cider vinegar dabbed on with a cotton ball. Don’t rinse toners after application - allow them to stay on your skin.
If your acne is severe, painful, or refusing to get lost, you may just be beyond what an over-the-counter treatment can do. Not only can a professional set you up with the really powerful stuff, but also Fitz Patrick explains that “working closely with an aesthetician or dermatologist means you can keep tweaking a routine to make it work best for you.”
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The side effects depend on the type of treatment you use. Generally, for topical, over-the-counter creams, you can watch out for stinging, redness, irritation and peeling — these side effects usually don’t go any deeper than the skin. Others, like oral antibiotics or hormonal medications, could come with new sets of complications, so we suggest talking to your doctor before pursuing the treatment.