Skin microbiome of patients with moderate acne treated with a fixed combination of “benzoyl peroxide 5% + clindamycin 1%” in combination with photodynamic therapy

Background. Vulgar acne is one of the most common dermatoses, affecting up to 85% of people aged 12 to 24 years. Four main links are distinguished in the pathogenesis of the disease, including inflammation and pathogenic activity of cutibacteria (Cutibacterium acnes), as well as other microorganisms (Staphylococcus and Malassezia spp).

Objective of the study. To study the facial skin microbiome in patients with moderate acne using gas chromatography-mass spectrometry before and after therapy with a fixed combination of «benzoyl peroxide (BP) 5% + clindamycin 1%» in combination with photodynamic therapy. Materials and methods. The skin microbiome of 40 patients (24 men, 16 women) with an established diagnosis of moderate acne was studied using gas chromatography-mass spectrometry (GC–MS) before and after (3 months) therapy. By randomization, two therapeutic groups were formed in equal numbers and gender ratios (12 men and 8 women, respectively) – the main group, which received a fixed combination of «benzoyl peroxide 5% + clindamycin 1%» (Zerkalin Intensive gel) in combination with photodynamic therapy, and a comparison group (monotherapy with «Zerkalin Intensive» gel). In addition to the qualitative and quantitative analysis by microorganism types, an assessment was made of the ratio of results for grouped microorganisms (loads of resident, transient, aerobic, anaerobic biota, loads of gram-positive and gram-negative bacteria, total bacterial load).

Results. It was found that in patients with acne, the total bacterial load (TBL) in the compared groups was exceeded by 8% and 7.9%, respectively. In both therapeutic groups, pronounced dysbiosis was revealed, which was characterized by an imbalance between total aerobes and anaerobes. Contamination with the former was exceeded by 310.6% (group I) and 187.5% (group II) (p<0.05), and the contamination with anaerobes, on the contrary, was reduced by 6.9% in group I and increased by 21.3% in group II (p><0.005). The total number of gram-positive bacteria was exceeded by 21.4% (group I) and 9.7% (group II) (p><0.05), gram-negative bacteria were reduced by 90.1% and 89.9% (p>0.5), respectively. At the end of 3 months of treatment, the quantitative indices of all six aerobes and four anaerobes of the resident microbiota in both groups returned to values close to the normative indices characteristic of healthy skin (p> 0.05). The greatest reduction in both therapeutic groups was observed in Propionibacterium spp. (by 90.4% and 78.8%, respectively (p<0.05)). A more pronounced reduction in the colonies of anaerobes of the transient microbiota over 12 weeks of therapy was observed in the main therapeutic group: Propionibacterium acnes was in the lead (78.4% versus 68.9% in group II, p><0.05). In the main therapeutic group, the reduction in resident biota contamination slightly prevailed over that in the comparison group (70.5% in group I and 68.9% in group II (p> 0.05).

Conclusion. Treatment of patients with moderate acne using a fixed combination of «benzoyl peroxide 5% + clindamycin 1%» in combination with photodynamic therapy has a significantly more pronounced effect on the elimination of anaerobes of both resident and transient microbiota.

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