2015 World Congress of Dermatology : Acne Episode 2 Brigitte Dreno


− Brigitte Dreno, you’re a specialist
in acne. You’ve come to the Congress this year. What are the hot topics in acne?
− I think that one of the most important topics in acne today is the interaction between
the cutaneous flora, i.e. the microbiota, and the inflammation, that means the innate immunity.
That is really new for us. − So, these are the bacteria that live on the skin? − Absolutely, you are right. Basically,
we know that P. Acnes plays an important role. We have a proliferation of P. Acnes which
is induced by hyperseborrhea, but this proliferation is able to modify quantitatively and qualitatively your microbiote and this modification induces signals through innate immunity and then inflammation.
That is why it is very important to maintain this cutaneous flora. − And how does one do that? − What we have to remember is that the use
of topical treatments or systemic treatments – I’m referring to cycline or isotretinoin
– will modify the cutaneous flora. To avoid that, the first step is to use the topical
treatment only in the evening and on all the face, not only on the spots. Then, you have
in the morning to use moisturizing cream to make it possible for the cutaneous flora,
which has been modified by your treatment, i.e. topical antibiotics or benzoyl peroxide
or topical retinoids, to go back to normal levels. The same goes for systemic treatments:
you need in the morning to use moisturizing cream. Another important point is the use of cleansers.
Often, people use soap, which they should avoid. Why? Because soap has a pH of 8, while the pH of human skin is around 5 or 5.5… − Hence very acid? − Absolutely. It is acid and thus, the use
of normal soap will induce signals through activation of your innate immunity, which
is bad. So, you need to use foaming soap with a pH that is around 5, which is acid, while
normal soap is basic – around 8. So, one of the important things in the role of the dermatologist
is to prescribe your patient with topical drugs or systemic drugs, but it is also important to prescribe and to discuss with them about dermocosmetics. − This seems like a complete new chapter for acne. − Absolutely, it is. Another important chapter is bacteria resistance. We tried to explain
to the dermatologists that today you have around 70% of P. Acnes strains that are resistant
to specific macrolides. It means that your topical antibiotic not only does not work,
but that it will induce a selection pressure on your cutaneous flora that results in the
development of staphylococcus or streptococcus which are resistant to macrolides. That is
a risk you do not want to take. − By getting these antibiotic-resistant
bacteria that are causing the acne and continuing with that treatment, which also knocks out
the normal bacterial flora, actually you could be making things worse?
− Absolutely. You may induce a flare-up or a relapse of your acne lesions by using
topical antibiotics or even systemic antibiotic on a long period, so you have to avoid using
topical antibiotics alone. Such treatment should be combined with benzoyl peroxide or
with a topical retinoid. Also, it can be interesting to use active dermocosmetics such as salicylic
acid niacinamide, a molecule that proved effective and well-tolerated and that never induces
bacteria resistance.

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