SKIN 
 

December 2018     Volume 2 Supplemental Issue  
 

Copyright 2018 The National Society for Cutaneous Medicine 95 

RISING DERM STARS 
 

 
The microbiome in preadolescent acne: assessment and prospective analysis 
on the influence of benzoyl peroxide 
Jusleen Ahluwalia MD1, Lawrence F Eichenfield MD1 
 
1Department of Dermatology, UC San Diego, San Diego, CA 

 
 
Background/Objectives: The pathogenesis 
of preadolescent acne has not been well 
studied, and it is uncertain if 
Propionibacterium acnes is a predominant 
organism in the microbiome in this age 
group.1-4 The aim of this study was to 
analyze the microbiome of preadolescent 
females, and to assess if benzoyl peroxide 
(BP) impacts the microbiome. 
 
Methods: The study enrolled females, aged 
7-12 years old, with evidence of at least six 
acneiform lesions who had not been 
previously treated with prescription acne 
products, BP, or had recently received oral 
antibiotics. Subjects’ skin surface of 
forehead, cheeks, nose, chin, left 
retroauricular crease and extruded contents 
of a comedonal lesion were sampled at 
baseline. Subjects utilized BP 4% wash for 6 
to 8 weeks and returned for skin surface 
sampling and extraction collection. 
Microbiome analysis was performed using 
16S ribosomal RNA gene amplicon 
sequencing on all swab and lesional 
extraction samples. 
 
Results: 51 subjects were enrolled with a 
median IgA score of 2 (mild). Changes in 
microbiome diversity were associated with 
increasing age and number of acneiform 
lesions (p=0.001) (Figure 1). P. acnes had 
higher abundances on forehead and nose, as 
opposed to cheeks and chin (p=0.009). 

Bacterial diversity (alpha diversity) of the skin 
microbiome was comparable between 
preadolescent at baseline and after treatment 
with benzoyl peroxide (Figure 2). 
 
Conclusion: This is the first large 
assessment characterizing female acne 
microbiome in early and late preadolescence. 
Results show that preadolescent acne can 
vary in its microbial profile, reflecting 
surrounding changes associated with the 
onset of puberty. Although benzoyl peroxide 
use was associated with decreased acne 
counts, its effect on microbial diversity was 
not demonstrated in our study.  
 
Figure 1: Bar plot of Bacterial Species according 
to Number of Acne Lesions. 

 
 
 



SKIN 
 

December 2018     Volume 2 Supplemental Issue  
 

Copyright 2018 The National Society for Cutaneous Medicine 96 

Figure 2: Phylogenetic Diversity in Visit 1 (pre-
treatment) and Visit 2 (post-treatment). Boxes 
indicate the 25th percentile, median, and 75th 
percentile. Outliers are represented by open dots. 
Whiskers show the minimum and maximum 
ranges. 

 
 

References: 
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