Phage Therapy: Acne Treatment

Acne: a Common Skin Condition Worldwide

The skin is home to a very complex microbial community – the skin microbiome. This community is delicately balanced by a wide variety of microorganisms including bacteria, viruses and fungi, normally living in harmony to function as the barrier to the skin. However, when this community is altered – this leaves us open to inflammatory skin diseases like acne vulgaris. Acne has been reported to be the eighth most common skin disease. In fact, it is estimated that by 21 years old, 80-90% of people will have experienced acne. Acne has a generally negative impact on health-associated quality of life and has been associated with higher rates of depression, low self-esteem, poor body image and anxiety. Therefore, the treatment of acne is becoming an area of intense scrutiny and research.

The cause of acne is multifactorial but is mainly associated with the bacterium Cutibacterium acnes (formerly Proprionibacterium acnes). C. acnes is the most abundant organism that lives on our skin. It has different strains, some that can live quite happily on healthy skin, and others that are associated with acne development. 

Acne has historically been treated with topical and oral antibiotics. Topical treatment is typically preferred due to its local effects and lack of side effects. However, the treatment of acne with antibiotics is increasingly becoming less effective due to the emergence of antibiotic resistance through the long-term use of antibiotics, which has led to high rates of antibiotic-resistant C. acnes strains.

In addition, the mechanism of antibiotics can unfortunately exacerbate the problem further. Antibiotic treatments will kill the specific strains of C. acnes that are causing the breakout but will also destroy other bacteria living in the skin microbiome that aren’t causing any problems. This will lead to another imbalance, and the cycle is likely to begin again. 

How are Bacteriophages Used to Treat Acne?

Bacteriophage therapy is becoming one of the most promising solutions for the treatment of acne that avoids antibiotic use. They are naturally occurring and harmless to the environment, making them an attractive treatment choice. Phages will replicate within the acne-causing bacteria and will be active at the site of the skin infection or acne. They will specifically kill their target without harming the other skin flora. This will help to maintain the skin’s natural community. They will also minimise the probability of a secondary infection occurring post-treatment. In addition, the isolation of new phages for treatment is an affordable and rapid process – much quicker than the development of new antibiotics. 

A recent study explored the feasibility of phage therapy to treat acne. This examined a direct topical application of eight novel phages to a mouse model of acne vulgaris caused by C. acnes. The model was produced by infecting mice with various C. acnes strains, from clinical isolates of patients with severe acne vulgaris. This study had positive results. Within the mouse model, some of the acne strains were resistant to antibiotics, the phages achieved 100% eradication of C. acnes. 

Acne can be caused by other bacteria in the skin microbiome such as Staphylococcus aureus. As with the study above, isolates of S. aureus were collected from clinical samples and phage therapy effectiveness was examined in biofilm formation. This study showed that biofilm formation was successfully inhibited by up to 95%.

Fixed Phage examined the use of immobilised bacteriophages to treat acne by targeting C. acnes. The skin was inoculated with the bacteria and treated with emollient creams combined with bacteriophages that were either ‘free’ or immobilised with nylon beads. This showed that there was a significant decrease in levels of bacteria on the skin treated with the cream containing immobilised phages. Not only this but within one hour, bacteria were eliminated. 

There is a range of evidence emerging from these studies supporting the use of bacteriophages as a treatment for acne.

Skincare Products with Bacteriophages / Phage-Based Skincare Products Development

Personal care products that are non-medicinal have different criteria to prescribed medication. Several skincare companies have been able to develop products that address skin issues without being classed as prescription medication and are therefore more openly available. Many of these products do not aim to simply target the acne-causing bacteria, but also to balance the skin’s microbiome. For example, diminishing overgrown, pathogenic strains of C. acnes, while allowing for other strains to develop which are present in healthy skin microbiota. The decrease in pathogenic bacteria gives other bacteria a chance to proportionally share the given microbiota. These skincare products are predominantly gels, creams, and serums. 

There are other applications of bacteriophages in skincare. Some health products are being produced based on phage mechanisms themselves. One example is endolysins or phage lysins. They are hydrolysing enzymes that bacteriophages produce during the final stage of the lytic cycle, to break down the bacteria. Skincare based on this mechanism has been developed to target S. aureus and resistant strains such as MRSA. This doesn’t just treat acne, but various other skin conditions with infectious components such as acne, rosacea and eczema. 

Is bacteriophage treatment FDA-approved?

The U.S. Food and Drug Administration (FDA) has approved some phage mixes for use in the food industry, to prevent food spoilage from bacteria. However, in the U.K. and EU, it has only been available for ‘compassionate use’, in instances where conventional antibiotics have failed.

The use of bacteriophages as medical treatments is currently still being looked into from the regulatory framework, but the field of personal care products is becoming an area of great interest for phage use. As we’ve mentioned, many topical skincare options are becoming available separately from prescription medication, so could be readily accessible sooner.

Conclusions and Future Prospects

Due to the chronic nature of acne, treatment is long-lasting, and often ineffective due to antibiotic resistance. The use of bacteriophages in the treatment of acne vulgaris is becoming an area of thorough research. Further investigations to achieve a detailed understanding of the skin microbiome and how it can interact with phages, will be fundamental in understanding acne vulgaris and finding appropriate therapeutic solutions.

If you would also like to learn more about Fixed Phage research or how you can support further findings through a potential partnership or investment, get in touch with us today.