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Fresh ideas about the causes of acne are bringing new treatments

We are finally working out what happens to the skin and gut microbiome when someone gets acne, giving us new targets for treatments

By Alexandra Thompson

13 November 2023

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Mary Maka

“HAVE you been bitten?”, an older woman asks me, gesturing to my spotty temple. It isn’t the first time this has happened. Normally, I go along with it to save enquirers the embarrassment, but today I have had enough. “It’s acne,” I tell her. Clearly uncomfortable, she reassures me it makes me look younger, presumably based on the notion that only teenagers have acne. Perhaps a passer-by in the street sees my pimples and pegs me at a youthful 17, rather than my actual 32 years. There’s a silver lining.

Acne affects more than 640 million people worldwide to some degree, often arising during puberty. As a teenager with blemish-free skin, I assumed I had escaped the danger zone relatively unscathed – since I didn’t have acne during my adolescence, surely my adult years were safe? My breakouts, however, took hold in my mid-20s, and I am not alone. It turns out acne can strike at any age.

Hormones undoubtedly play a part, but they are far from the only culprit: diet, lifestyle and genetics have been implicated too. There is one offender, however, whose contribution to acne has long been suspected, but has proved difficult to pin down. I am talking about our microbiome – microbes that reside in our gut, on our skin and in our hair follicles.

Now, a flurry of new evidence and a leap in the technology that lets us study this microscopic community have led to a shift in our understanding of acne. For the first time, we can actually see what is happening on our skin during a breakout, and these insights are offering up…

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