Overview
Propionibacterium acnes (now often referred to as Cutibacterium acnes) folliculitis is a common inflammatory skin condition involving the pilosebaceous units 1. It arises from a complex interaction between skin physiology and the cutaneous microbiome, where dysbiosis and overproliferation of C. acnes can contribute to pathogenesis 1.Diagnosis
Management
Topical treatments: Benzoyl peroxide (BPO) is identified as a treatment that modulates the cutaneous microbiome 1.
Systemic treatments: Doxycycline is mentioned as a treatment that modulates the cutaneous microbiome 1. Isotretinoin is also noted as a treatment that modulates the cutaneous microbiome 1.
Photodynamic therapy: Aminolevulinic acid-photodynamic therapy (ALA-PDT) is identified as a treatment that modulates the cutaneous microbiome 1.
Adjunctive therapies: Oral probiotics, specifically Lacticaseibacillus rhamnosus (CECT 30031) and Arthrospira platensis* (BEA_IDA_0074B), have shown efficacy in improving acne severity and reducing non-inflammatory lesions 3. Other oral nutraceuticals, including vitamins B5 and D, green tea extract, and ω-3 fatty acids, may also be beneficial 4.
Acne scar treatment: Combination therapy with air-botulinum toxin and polydeoxyribonucleotide (PDRN) injections has shown promise for acne scar management 2.Special Populations
Key Recommendations
Oral probiotics, such as Lacticaseibacillus rhamnosus and Arthrospira platensis, may be considered for acne vulgaris patients due to demonstrated efficacy and good tolerability 34. (Evidence: Moderate)
Treatments like benzoyl peroxide, doxycycline, isotretinoin, and ALA-PDT modulate the cutaneous microbiome, contributing to their efficacy in acne treatment 1. (Evidence: Moderate)
Combination therapy with air-botulinum toxin and PDRN injections shows potential for improved acne scar management compared to single treatments 2. (Evidence: Weak)References
1 Podwojniak A, Tan IJ, Sauer J, Neubauer Z, Rothenberg H, Ghani H et al.. Acne and the cutaneous microbiome: A systematic review of mechanisms and implications for treatments. Journal of the European Academy of Dermatology and Venereology : JEADV 2025. link
2 Park MH, Hwang SK, Hwang JK, Chua D, Yi KH. Air-Botulinum Neurotoxin and Polydeoxyribonucleotide Injections for Acne Scar Treatment. Aesthetic plastic surgery 2025. link
3 Eguren C, Navarro-Blasco A, Corral-Forteza M, Reolid-Pérez A, Setó-Torrent N, García-Navarro A et al.. A Randomized Clinical Trial to Evaluate the Efficacy of an Oral Probiotic in Acne Vulgaris. Acta dermato-venereologica 2024. link
4 Shields A, Ly S, Wafae B, Chang YF, Manjaly P, Archila M et al.. Safety and Effectiveness of Oral Nutraceuticals for Treating Acne: A Systematic Review. JAMA dermatology 2023. link
5 Lam M, Hu A, Fleming P, Lynde CW. The Impact of Acne Treatment on Skin Bacterial Microbiota: A Systematic Review. Journal of cutaneous medicine and surgery 2022. link