SKIN MICROBIOME AND ACNE VULGARIS: STAPHYLOCOCCUS, A NEW ACTOR IN ACNE
B. DRENO1,2, R. MARTIN3, A. KHAMMARI1,2, D. MOYAL4, J.B. HENLEY5, S. SEITE4

INTRODUCTION

METHODS

RESULTS

CONCLUSION

Acne is a chronic inflammatory disease targeting the pilosebaceous follicle. Propionibacterium acnes (P. acnes), 
the sebaceous gland and follicular keratinocytes play a role in the development of acne. Together they induce 
inflammation in the follicle by activating the innate immunity. For several years, the role of Staphylococcus, 
another bacterium genus, has been discussed in the development of acne. However, to date its role has never been 
demonstrated. The objective of this study was to investigate the characteristics of the microbiome on unaffected 
skin and acne lesions (comedone and papulo-pustular lesions) and to determine changes after applying either 
erythromycin 4% or a dermocosmetic containing lipohydroxy acid, salicylic acid, linoleic acid, niacinamide, 
piroctone-olamine, a ceramide and Thermal Spring Water for 28 days.

The study showed that in subjects with acne, 
the bacterial diversity is similar on the surface of 
unaffected skin as well as on comedones and papulo-
pustular lesions. Before and after treatment with either 
a topical antibiotic or a dermocosmetic, Staphylococci 
remained the predominant genus of the superficial 
skin microbiota of acne lesions as well as of the 
unaffected skin.

(1)Department of Dermato-Cancerology, Nantes University, Nantes, France, (2)CRCNA, Inserm U892, CNRS 6299, Nantes, France, (3)L’Oréal Research & Innovation, Tours, France, 
(4)La Roche-Posay Dermatological Laboratories, Asnières, France, (5)Cooperative Institute for Research in Environmental Sciences, University of Colorado, Boulder, Colorado, USA

This single-centre controlled, randomized, double blinded, intra-individual study was conducted in 55 subjects 
with mild to moderate acne (GEA Grading)(1) before and after treatment either with a dermocosmetic formulation or 
a topical antibiotic. Microbiota were collected with swabs at D0 and D28, under axenic conditions from 3 sites 
(comedones, papulo-pustular lesions and unaffected or clinically healthy looking skin) and characterised using a 
high-throughput sequencing approach that targets a portion of the 16S rRNA bacterial gene(2).

An overabundance of Proteobacteria and Firmicutes and an underrepresentation of Actinobacteria on the skin surface 
of subjects with acne were observed. Moreover, Proteobacteria were less abundant in areas with comedones and 
papulo-pustular lesions than in unaffected skin areas (29% vs 34% - p=0.001 and 31% vs 34% - p=0.05) while Firmicutes 
were more abundant in zones with comedones (52% vs 47% - p=0.002). No difference for Actinobacteria was evidenced.

Main bacterial Phyla on the skin surface of the 3 sampled areas (comedones (B), papulo-pustules (C) and healthy skin (A)) at D0 (n=26)

13.7514.1413.6234.1
31.2928.9

p_Proteobacteria

• •
•

p=0.001 p=0.050

%

10
2

0
3

0
4

0
5

0
6

0
70

B C A B C A

*

*

*

•
52.01

*
p=0.002 p=0.084

49.26
•%

3
0

2
0

4
0

5
0

6
0

70
8

0

p_Firmicutes

%

5
10

15
2

0
2

5
3

0

• • •

*

p=0.903 p=0.650

B C A

p_Actinobacteria

47.01•

Staphylococci were more abundant on the surface of comedones and papulo-pustular lesions (p=0.004 and p=0.003 
respectively) compared to unaffected skin. Propionibacteria represented less than 2% of the bacteria characterised.

Main bacterial phyla and genus in percentage at the skin surface of the 3 sampled areas 
(comedones, papulo-pustular and unaffected skin) at D0 (n=26) 

Area

PHYLUM GENUS
Comedones

(%) 
Papulo-pustular

(%) 
Unaffected skin

(%) 
Actinobacteria

Propionibacterium 
Corynebacterium

Other Actinobacteria

13,61
1,04
7,93
4,64

14,15
1,20
8,54
4,40

13,75
1,36
7,71
4,69

Firmicutes
Staphylococcus

Other Firmicutes

52,01*
33,87*
18,14

49,27
34*

15,27

47,01
26,85
20,16

Proteobacteria 28,90* 31,30* 34,10

Bacteroidetes 4,16 3,78 3,73

Fusobacteria 0,73 0,84 0,64

Other 0,58 0,67 0,76

*p<0.05 versus unaffected skin

Staphylococcus genus at the skin surface of 3 sampled areas (comedones (B), papulo-pustules (C) 
and healthy skin (A)) in GEA-2 (n=16) and GEA-3 (n=10) at D0

After one month of treatment, erythromycin was mainly effective on Actinobacteria while the dermocosmetic was 
effective on both Actinobacteria and Staphylococcus.

Main bacterial phyla and genus in percentage at the skin surface of the 3 sampled areas (comedones, papulo-pustular and unaffected skin) for 
the hemi-face receiving Erythromycin 4% or the dermocosmetic after (Day 28) treatment (n=26)

Day 28 - Erythromycin Day 28 - Dermocosmetic

PHYLUM GENUS
Comedones

(%) 
Papulo-pustular

(%) 
Unaffected zone

(%) 
Comedones

(%) 
Papulo-pustular

(%)
Unaffected zone

(%)
Actinobacteria

Propionibacterium 
Corynebacterium

Other 
Actinobacteria

11,89*
0,82**
5,87*

5,20

11,09
0,82
5,72

4,56

11,98
1,22
5,88

4,89

11,56
0,64
7,37

3,56

10,87*
0,76

5,27*
4,84

11,25
1,06

4,95**

5,25

Firmicutes
Staphylococcus

Other 
Firmicutes

49,43
27,04

22,39

43,79
24,53**

19,30

45,80
24,91

20,91

44,55
19,96*

24,60

47,11
26,24**

20,89

46,40
23,52

22,92

Proteobacteria 30,54 36,32 37,15 35,60 33,19 33,95

Bacteroidetes 5,21 4,87 3,61 5,11 5,52 5,32

Fusobacteria 0,62 0,49 0,38 0,65 0,81 0,51

Other 2,27* 3,28* 1,01 2,48** 2,45 2,41**

1653.9

10
0

0
3

0
0

0
5

0
0

0

GEA-2 GEA-3

0.022

2636.2•

A B

0
10

0
0

3
0

0
0

5
0

0
0

0

GEA-2 GEA-3

0.063

1719•
2662.4•

0
10

0
0

3
0

0
0

5
0

0
0

GEA-2 GEA-3

C

0.037

1262.6•
2167.5•

•

*p<0.05 versus Day 0, **p<0.1 versus Day 0

A B
20

15

10

5

0
D0 D28

p<0.0001

p<0.0001

Comedones

p=0.37

Papulo-pustules

p=0.88

0

5

10

15

D0 D28

9,4

5,2

20

15

10

5

0
D0 D28

p<0.0001

p<0.0001

0

5

10

15

D0 D28

15,3
11,9

16
11,8

9,7
5,2

In addition, a significant reduction of both comedones and papulo-pustular lesions with no significant 
difference between the products was observed.

Reduction of the number of papulo-pustular lesions and comedones on 
both hemi-faces after 28 days of treatment with either erythromycin (A) 

or the dermocosmetic (B) (n=26, values are expressed in mean±SD)

REFERENCES
1. Dreno B, Poli F, Pawin H, et al. Development and evaluation of a Global Acne Severity Scale (GEA Scale) suitable for France and Europe. J Eur Acad Dermatol 
Venereol: 2011: 25: 43-48
2. Caporaso JG, Lauber CL, Walters WA et al. Global patterns of 16S rRNA diversity at a depth of millions of sequences per sample. Proc Natl Acad Sci USA, 
2011: 108 Suppl 1: 4516-4522

In all 3 sampled areas, Staphylococci proportions increased with the acne severity (p<0.05 between GEA-2 and GEA-3).


	FC17PosterLaRocheDrenoSkinMicrobiome.pdf