Microbiology of acne

A  role for micro-organisms in  acne  has been  championed since the beginning of the twentieth century and enthusiasm for this idea has fluctuated ever since. To appreciate the arguments and present position  within this subject an understanding of clinically normal skin microbiology is  essential. This will be discussed here together with the description  and physiology  of the micro-organisms,  their numbers  on the skin, their possible role in acne and the effects of antimicrobial treatment on the skin flora.

Propionibacteria have received most attention with regard to acne.  However, at present there is no formal proof that these bacteria are the cause, or one of the causes, of this disease.

Consequently, information is presented on all the groups of microorganisms  found in acne-affected skin. At present it is not possible to decide  whether the microflora are initiators of the lesions, or whether they take advantage of the habitat in the lesion, or whether a critical balance of groups of micro-organisms occupying a follicle is the essential factor for acnegenesis. It  is evident that the follicular microflora is more important than  the skin surface micro-organisms.