eISSN: 2299-0046
ISSN: 1642-395X
Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii
Current issue Archive Manuscripts accepted About the journal Editorial board Reviewers Abstracting and indexing Subscription Contact Instructions for authors Ethical standards and procedures
SCImago Journal & Country Rank
 
6/2022
vol. 39
 
Share:
Share:
more
 
 
Letter to the Editor

Acne conglobata caused by Cutibacterium avidum

Jiao Jiang
1
,
Jun Tang
2
,
Yixin Tan
1
,
Ruifang Wu
1
,
Shuaihantian Luo
1

1.
Department of Dermatology, the Second Xiangya Hospital of Central South University, Changsha, Hunan, China
2.
Department of Dermatology, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
Adv Dermatol Allergol 2022; XXXIX (6): 1183-1185
Online publish date: 2022/12/22
Article file
- Acne conglobata.pdf  [0.17 MB]
Get citation
ENW
EndNote
BIB
JabRef, Mendeley
RIS
Papers, Reference Manager, RefWorks, Zotero
AMA
APA
Chicago
Harvard
MLA
Vancouver
 
 

A 30-year-old man presented to our hospital with a 2-year history of massive inflammatory, nodulocystic, and painful lesions as well as an aggravation for 2 months. Clinical examinations revealed that there were massive red papules, pustules, nodules, and cysts scattered over the skin of his whole cheeks and neck, and part of his shoulder and back. Most of the pustules were filled with white secretion, and some were damaged with crust (Figure 1). A rectal temperature was 37°C.

Figure 1

A – The anterior view of a 30-year-old man with acne conglobata. B – The left side view of a 30-year-old man with acne conglobata. C – The right side view of a 30-year-old man with acne conglobata. D – The posterior view of a 30-year-old man with acne conglobata

/f/fulltexts/PDIA/48911/PDIA-39-48911-g001_min.jpg

He has taken oral isotretinoin (20 mg daily for 3 months) and nadifloxacin ointment for the therapy, but there was no significant improvement on him and the number of his skin lesions has increased.

During the hospitalization, he was diagnosed with acne conglobata through his physical examination. In his laboratory examinations, the white blood cell count (15.15 × 109/l) and neutrophil count (10.60 × 109/l) in blood routine tests were increased. The erythrocyte sedimentation rate (ESR) (40 mm/h) and C-reactive protein (CRP) (27.60 mg/l) were also significantly elevated (Figure 2).

Figure 2

Colony morphologies of C. avidum of the facial pustules of this patient on Schaedler agar plates after incubation

/f/fulltexts/PDIA/48911/PDIA-39-48911-g002_min.jpg

We got the secretion sample for microbiological detection. However, no bacteria and fungi were found in the secretions in the microscopic examination. The Gram stain and acid-fast staining were also negative. But in the secretion culture of his facial secretions, the Cutibacterium (formerly Propionibacterium) avidum (C. avidum) colonies were found in the Brucella blood agar plate.

Then we used a daily dose of intravenous moxifloxacin hydrochloride (400 mg), oral isotretinoin (10 mg three times), and topical use of mupirocin ointment and nadifloxacin ointment. After a week of therapy, the skin lesions improved and he was discharged with the therapy of a daily dose of oral amoxicillin (1.5 g), isotretinoin (10 mg three times), and aforementioned external medicines. Finally, this patient had complete resolution of his symptoms at 4 months’ follow-up.

Acne conglobata is a rare and severe type of acne with interconnecting inflammatory and grouped nodules, cysts, and abscesses [1]. Acne conglobata is often resistant to conventional therapies for acne and heals with disfiguring scarring, resulting in a big impact on the mental health and patients’ quality of life [1]. Although this patient had an elevated white blood cell count, ESR and CRP, the 2-year medical history as well as numerous persistent polyporus comedones and non-inflammatory cysts suggested that the diagnosis was dominated by acne conglobata rather than acne fulminans [2]. In decades, microorganisms on the skin surface have been considered to be one important factor of acne conglobata [13]. According to previous studies, C. acnes is believed to be involved in the chronic inflammatory state, leading to the presence of acne vulgaris [2]. However, it is not the proliferation of C. acnes but C. avidum that has been observed in the facial secretion of this patient. Thus, we supposed that this case may be caused by C. avidum.

C. avidum and C. acnes are prevalent species colonized on the skin tissues in both healthy people and patients with acne. C. acnes tends to reside in the skin regions with excessive sebum and is the main pathogen of acne. While C. avidum is a type of human cutaneous commensals in maintaining skin homeostasis and usually colonized in regions with eccrine sweat glands, such as nares, axilla, groin, and the perianal region [4]. It is a low pathogenic form but can be an opportunistic deep infection, instrumentation procedures, and immunodeficiency [4]. In previous reports, the C. avidum infections usually occurred in patients after the surgery or instrumentation procedures, such as breast implant infection and skin abscesses [4].

Interestingly, we firstly reported a rare case of acne conglobata caused by C. avidum infection. To date, there have been few reports in the literature or researches about the pathogenetic role of C. avidum in acne. We speculate that the possible pathogenic mechanisms of C. avidum in the acne conglobata are as follows: Firstly, C. avidum belongs to cutaneous commensals and the trauma, surgery, device, as well as immunosuppressant intake can be the contributors of C. avidum infections in previous evidence. Here, we speculated that the destruction of the skin barrier and microenvironment may promote the proliferation of C. avidum in this patient. Besides, C. avidum is capable of hydrolysing triacylglycerols and thereby increasing short chain fatty acids, which are thought to be the key factors in promoting inflammation in acne [5]. In addition, the formation of the biofilm in C. acnes leads to the amplification of inflammation and activation of innate immune in acne. Thus, the biofilm formation in C. avidum which can contribute to the persistent infections may play a role in the pathogenesis of acne conglobata [3]. Moreover, the C. avidum have high levels of catalase activity that cause oxidative stress in the pathogenesis of acne [4, 6]. What is more, C. avidum has more tryptamine-like activity and the tryptamine produced by C. avidum may lead to sebaceous inflammation [4]. Moreover, some bioactive substances produced by C. avidum, such as neuraminidase, propionicins, and lecithinase may also participate in the progression of acne conglobata [4]. Although C. avidum is a potential pathogen of acne conglobate, more attention and investigations about the functions of C. avidum are further needed.

As for the antimicrobial susceptibility of C. avidum, the β-lactams, rifampin, fluoroquinolones, and macrolides have a good antibacterial activity, whereas the erythromycin and clindamycin have low activity [4]. Recently, clarithromycin, and ciprofloxacin resistance were observed in C. avidum strains [7, 8]. In previous studies, benzoyl peroxide may be anti-inflammatory and antibacterial treatment and can prevent the occurrence of antibiotic resistance by resistant mutant selection [5, 9].

In conclusion, this is the first case presented as acne conglobata caused by C. avidum infection. It is necessary for the dermatologist to confirm the microorganism isolated from the facial secretions of patients with acne conglobate and select the sensitive antibiotic treatment. The good news is that C. avidum remains sensitive to most antibiotics so far. However, since there are few studies on the C. avidum infections in acne conglobate, more researches on C. avidum are still urgently needed.

Acknowledgments

The authors want to thank Dr. Chuanhao Jiang for his help in providing pictures.

This work was supported by the National Natural Science Foundation of China (81703133) and Natural Science Foundation of Hunan Province (2019JJ40448, 2020JJ3055).

Conflict of interest

The authors declare no conflict of interest.

References

1 

Myers JN, Mason AR, Gillespie LK, et al. Treatment of acne conglobata with modern external beam radiation. J Am Acad Dermatol 2010; 62: 861-3.

2 

Koceva I, Rümmelein B, Gerber PA, et al. Fluorescent light energy: a new therapeutic approach to effectively treating acne conglobata and hidradenitis suppurativa. Clin Case Rep 2019; 7: 1769-72.

3 

Greydanus DE, Azmeh R, Cabral MD, et al. Acne in the first three decades of life: an update of a disorder with profound implications for all decades of life. Dis Mon 2021; 67: 101103.

4 

Corvec S. Clinical and biological features of Cutibacterium (formerly Propionibacterium) avidum, an underrecognized microorganism. Clin Microbiol Rev 2018; 31: e00064-17.

5 

Edwards HD, Shelver WL, Choi S, et al. Immunogenic inhibition of prominent ruminal bacteria as a means to reduce lipolysis and biohydrogenation activity in vitro. Food Chem 2017; 218: 372-7.

6 

Kardeh S, Moein SA, Namazi MR, et al. Evidence for the important role of oxidative stress in the pathogenesis of acne. Galen Med J 2019; 8: e1291.

7 

Koizumi J, Nakase K, Hayashi N, et al. Multidrug-resistant Cutibacterium avidum isolated from patients with acne vulgaris and other infections. J Global Antimicrob Resist 2022; 28: 151-7.

8 

Walsh TR, Efthimiou J, Dréno B. Systematic review of antibiotic resistance in acne: an increasing topical and oral threat. Lancet Infect Dis 2016; 16: e23-33.

9 

Mak TN, Schmid M, Brzuszkiewicz E, et al. Comparative genomics reveals distinct host-interacting traits of three major human-associated propionibacteria. BMC Genomics 2013; 14: 640.

Copyright: © 2022 Termedia Sp. z o. o. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
 
Quick links
© 2023 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.