Abstract
Antibiotic-resistant Cutibacterium acnes and dysbiosis of the skin microbiome are of increasing concern in acne treatment. Enterococcus faecalis, a widely used probiotic, has shown benefits for acne treatment by exerting antimicrobial activity against C. acnes. Therefore, this study aimed to investigate the efficacy and safety of an E. faecalis CBT SL-5-extract-containing lotion in patients with mild-to-moderate acne. Twenty patients were enrolled in this randomized, placebo-controlled, split-face comparative study. Patients were treated with E. faecalis lotion on one side of the face and a vehicle lotion on the other side for 4 weeks. The efficacy outcome measures included improvement in the investigators’ assessment of acne severity, patient satisfaction, changes in skin parameters and diversity of the skin microbiome. The investigators’ assessment score was significantly improved on the test side compared to the control side, after 2 weeks (p = 0.009) and 6 weeks (p < 0.0005). However, TEWL and skin hydration were not significantly different between the two groups. The phylogenetic diversity of the skin microbiota decreased over time in the skin samples of test side. In conclusion, E. faecalis CBT SL-5 extract can be a feasible and well-tolerated option for improving acne severity and skin microbiome dysbiosis in mild-to-moderate acne patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Explore related subjects
Discover the latest articles and news from researchers in related subjects, suggested using machine learning.Data Availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Change history
04 July 2022
An Erratum to this paper has been published: https://doi.org/10.1007/s12275-022-1682-2
References
Adler, B.L., Kornmehl, H., and Armstrong, A.W. 2017. Antibiotic resistance in acne treatment. JAMA Dermatol. 153, 810–811.
Armstrong, G., Cantrell, K., Huang, S., McDonald, D., Haiminen, N., Carrieri, A.P., Zhu, Q., Gonzalez, A., McGrath, I., Beck, K.L., et al. 2021. Efficient computation of Faith’s phylogenetic diversity with applications in characterizing microbiomes. Genome Res. 31, 2131–2137.
Bolyen, E., Rideout, J.R., Dillon, M.R., Bokulich, N.A., Abnet, C.C., Al-Ghalith, G.A., Alexander, H., Alm, E.J., Arumugam, M., Asnicar, F., et al. 2019. Reproducible, interactive, scalable and extensible microbiome data science using QIIME2. Nat. Biotechnol. 37, 852–857.
Chien, A.L., Tsai, J., Leung, S., Mongodin, E.F., Nelson, A.M., Kang, S., and Garza, L.A. 2019. Association of systemic antibiotic treatment of acne with skin microbiota characteristics. JAMA Dermatol. 155, 425–434.
Chikviladze, D.P., Metreveli, D.A., Gachechiladze, K.E., and Mikeladze, M.L. 2012. Antibiotic resistance of nosocomial strains of Staphylococcus spicies. Georgian Med. News 202, 60–63.
Dréno, B., Kaufmann, R., Talarico, S., Torres Lozada, V., Rodríguez-Castellanos, M.A., Gómez-Flores, M., De Maubeuge, J., Berg, M., Foley, P., Sysa-Jedrzejowska, A., et al. 2011. Combination therapy with adapalene-benzoyl peroxide and oral lymecycline in the treatment of moderate to severe acne vulgaris: a multicentre, randomized, double-blind controlled study. Br. J. Dermatol. 165, 383–390.
Dréno, B., Martin, R., Moyal, D., Henley, J.B., Khammari, A., and Seité, S. 2017. Skin microbiome and acne vulgaris: Staphylococcus, a new actor in acne. Exp. Dermatol. 26, 798–803.
Juda, M., Chudzik-Rzad, B., and Malm, A. 2016. The prevalence of genotypes that determine resistance to macrolides, lincosamides, and streptogramins B compared with spiramycin susceptibility among erythromycin-resistant Staphylococcus epidermidis. Mem. Inst. Oswaldo Cruz 111, 155–160.
Kang, B.S., Seo, J.G., Lee, G.S., Kim, J.H., Kim, S.Y., Han, Y.W., Kang, H., Kim, H.O., Rhee, J.H., Chung, M.J., et al. 2009. Antimicrobial activity of enterocins from Enterococcus faecalis SL-5 against Propionibacterium acnes, the causative agent in acne vulgaris, and its therapeutic effect. J. Microbiol. 47, 101–109.
Karadag, A.S., Aslan Kayiran, M., Wu, C.Y., Chen, W., and Parish, L.C. 2021. Antibiotic resistance in acne: changes, consequences and concerns. J. Eur. Acad. Dermatol. Venereol. 35, 73–78.
Kelhälä, H.L., Aho, V.T.E., Fyhrquist, N., Pereira, P.A.B., Kubin, M.E., Paulin, L., Palatsi, R., Auvinen, P., Tasanen, K., and Lauerma, A. 2018. Isotretinoin and lymecycline treatments modify the skin microbiota in acne. Exp. Dermatol. 27, 30–36.
Kim, J., Park, T., Kim, H.J., An, S., and Sul, W.J. 2021. Inferences in microbial structural signatures of acne microbiome and mycobiome. J. Microbiol. 59, 369–375.
Lee, Y.B., Byun, E.J., and Kim, H.S. 2019. Potential role of the microbiome in acne: a comprehensive review. J. Clin. Med. 8, 987.
Lee, Y.J., Choi, H.J., Kang, T.W., Kim, H.O., Chung, M.J., and Park, Y.M. 2008. CBT-SL5, a bacteriocin from Enterococcus faecalis, suppresses the expression of interleukin-8 induced by Propioni-bacterium acnes in cultured human keratinocytes. J. Microbiol. Biotechnol. 18, 1308–1316.
Li, C.X., You, Z.X., Lin, Y.X., Liu, H.Y., and Su, J. 2019. Skin microbiome differences relate to the grade of acne vulgaris. J. Dermatol. 46, 787–790.
Lucky, A.W., Cullen, S.I., Funicella, T., Jarratt, M.T., Jones, T., and Reddick, M.E. 1998. Double-blind, vehicle-controlled, multicenter comparison of two 0.025% tretinoin creams in patients with acne vulgaris. J. Am. Acad. Dermatol. 38, S24–S30.
Omer, H., McDowell, A., and Alexeyev, O.A. 2017. Understanding the role of Propionibacterium acnes in acne vulgaris: the critical importance of skin sampling methodologies. Clin. Dermatol. 35, 118–129.
Park, S.Y., Kim, H.S., Lee, S.H., and Kim, S. 2020. Characterization and analysis of the skin microbiota in acne: impact of systemic antibiotics. J. Clin. Med. 9, 168.
Acknowledgements
This research was supported by the Chung-Ang University Research Grants in 2020 and the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2020R1H1A1099969). The patients in this manuscript have given written informed consent to publication of their case details.
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Conflict of Interest Sanghyun Lim, Dooheon Son, and Myung Jun Chung are principal researcher, researcher, and CEO respectively at Cell Biotech, Co., Ltd.
Ethical Statements This double-blind, randomized, placebo-controlled, split-face study was approved by the Institutional Review Board of Chung-Ang University Hospital (Approval No. 1962-005-376). The study was conducted in accordance with the principles of the Declaration of Helsinki.
Supplementary Materials and Methods
Rights and permissions
About this article
Cite this article
Han, H.S., Shin, S.H., Choi, BY. et al. A split face study on the effect of an anti-acne product containing fermentation products of Enterococcus faecalis CBT SL-5 on skin microbiome modification and acne improvement. J Microbiol. 60, 488–495 (2022). https://doi.org/10.1007/s12275-022-1520-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12275-022-1520-6