Every year, along with Accutane, dermatologists dish out antibacterial cleansers and face wipes to millions of patients. If your dermatologist ever gave you Benzoyl Peroxide cream, it was supposed to help by killing p.acnes bacteria. The market for all manner of bacteria killing topical treatments is worth billions.
However, they’re clearly not working. Why? The reality is that bacteria is only one piece of the puzzle. Tackling chronic inflammation, nutritional deficiencies and sebum oxidation is just as important. If you’ve just been using BP then there’s a goldmine of fresh opportunities for you to tap.
But bacteria is still important. It’s a complicated subject, so in this article we’ll cut through the nonsense and allow you to understand the science properly. We will discuss following topics:
- What is p.acnes bacteria?
- How does p.acnes cause acne?
- How does an overgrowth of p.acnes happen?
- Why do acne patients have higher quantities of p.acnes in their pores than average?
- What can be done about it?
Read on and you’ll gain some of the most important acne knowledge there is…
Propionibacterium acnes – the bacteria acne patients fear
Your skin is filled with endless species of bacteria, and it’s p.acnes that is responsible for pimples. Firstly, p.acnes is not unhealthy at all. Moderate amounts are found in the natural skin flora of most adult humans alive.
P.acnes grows naturally in the pores of your face, neck and upper chest, and also in areas of intestines. It’s a member of the gram positive family of bacteria, and it was formerly known as Bacillus acnes or Corynebacterium acnes.
P.acnes is an oxygen tolerant bacteria, but it prospers and grows in lower-oxygen environments. Hence, p.acnes is mostly found deep within the pores and hair follicles of your skin rather than the surface. P.acnes uses sebum, the oil produced by your sebaceous glands, as a primary fuel source.
Certain strains of p.acnes actually have beneficial roles, like manufacturing immune agents which target and destroy viruses trying to enter your skin. There are at least 70 strains of p.acnes, with some protecting the skin from acne and others causing it (update 27/7/17: here’s a full article on these different strains, and why some are much worse).
According to a study published in the Journal of Investigative Dermatology, clear skinned patients have strains of p.acnes which don’t appear in the skin of acne patients at all. Likewise, clear skin generally has far less of the certain strains which acne patients have in abundance.
The big question is – what allows these evil strains to grow at the expense of the friendly ones?
The answer is simple: the villainous strains thrive in blocked pores. The best environment for p.acnes to grow exponentially is one with low oxygen. When a skin pore fills up with sebum and dead skin cells, the oxygen tension falls slightly, to a level that’s optimal for p.acnes to grow.
Next, the massive overload of sebum responsible for blocking that pore provides a huge fuel supply. P. acnes bacteria uses sebum, which is produced in follicles and pores, as a primary source of energy.
The bacteria is equipped with a specialized enzymes called lipase that digests the fatty acids and triglycerides, like squalene, which sebum is consisted of. This again helps p.acnes to expand exponentially.
Making matters worse is that as p.acnes ferments sebum with its bacterial enzymes, many metabolic by-products are produced. The most abundant is propionic acid, a harmless substance which gives Propionibacterium acnes its name. But several enzymes and waste products are produced which are highly comedogenic, meaning they block your pores.
In fact, the digestion of sebum’s triglycerides is specifically adapted to increase the potential for its growth, by reinforcing the conditions favourable to it. There’s even evidence that the mere presence of p.acnes stimulates even more sebum production. Basically, p.acnes is terrific at entrenching itself. Once the overgrowth starts it begins a downward spiral.
P.acnes can also multiply so fast it creates stick clumps of bacteria called biofilms, which help to anchor and defend the existing bacteria in the pore. Biofilms are a key feature of long term infections; conditions like candida and athletes are stubborn because of these tough bacterial structures. Once in place, biofilms make your efforts to clean the pores far more challenging. .
Basically, any bodily condition that leads to high sebum production and/or blocked pores can help the bad strains of p.acnes to grow. Unbalanced hormones, excessive keratin production, vitamin deficiencies, and even commonplace conditions like sleep deprivation are all reasons why your pores are full of bacteria, and clear-skinned peoples are not.
How p.acnes triggers an acne explosion
P.acnes mainly creates pimples in the pores it inhabits thanks to inflammation. Firstly, some of the by-products produced by p.acnes have localised inflammatory effects. When oxygen tension is low, p.acnes is stimulated to manufacture a compound called porphyrin that react with oxygen to create reactive oxygen species, or free radicals. Free radicals cause chain reactions that weaken the structure of skin cells.
The digestion of sebum also produces bacterial debris, metabolic by-products, and fatty acids which are all inflammatory. All these by-products can combine to redden the pore, swell it, weaken the surrounding cells, and cause general damage that creates what we call a pimple.
However, this minor inflammation pales in comparison to the real threat: your immune system’s large response to p.acnes. Many of the individual compounds that p.acnes is made from are easily recognised by your immune system as “enemy” molecules. These materials includes components of the bacterial cell wall, like lipopolysaccharides, peptidoglycans and proteins, and the metabolic by-products mentioned above.
The DNA of p.acnes bacteria is also recognized as foreign by your immune system. Even dead p.acnes bacteria can be viewed as a threat and treated to a response.
With your pores getting ever more blocked and p.acnes multiplying further and further, your immune system believes it has a large threat to deal with. Its solution is to bombard p.acnes with a barrage of inflammatory chemicals. White blood cells, cytokines like interleukin-6 and TNF-a, and other chemicals are all dispatched to your pores.
They usually succeed in their mission to give p.acnes a good kicking. The problem is the massive collateral damage. In the process, these chemicals weaken the surrounding pore; they weaken and redden the cells and surrounding tissues. Actors like neutrophils spew out free radicals which cause chain reactions of havoc in your pore.
Much like a wound from a bicycle crash might swell up after your immune system deals with it, so too does your pore. It develops all the characteristics of a pimple that we know and love.
That’s the basics of how bacteria causes acne. Your pores get blocked, p. acnes overgrows like mad, and your immune system launches an over-the-top assault against it which inflames the pore.
Why normal antibacterial products fail
Treatments like BP and antibiotics do make sense; their job is to blast p.acnes off the face of the earth so that the resulting immune response doesn’t happen. But most of the antibacterial treatments used by millions are flawed in many ways.
First we have Benzoyl Peroxide, which works by breaking down into benzoic acid and oxygen upon contact with the skin. The oxygen forms free radicals which travel into your pores and destroy the p.acnes. The process does work and that’s why BP helps a minority of acne patients…
…but the free radicals cause massive collateral damage. Roughly 12% of your sebum consists of squalene. If you’re a regular reader here then you’ll know that oxidised squalene is a big factor behind blocked pores; it forms a by-product called squalene peroxide that both increases sebum production locally and creates big clumps of dead skin cells. Much of the advice on this website is geared towards protecting your sebum from oxidation.
Well, the free radicals that BP generates are terrific at oxidising your sebum. Worse, they also directly weaken your skin’s structural cells and cause inflammation. The result is that BP increases your acne in the long run, by blocking your pores, and also inflaming your healthy tissues. It’s a similar story for many other antibacterial products; they rely far too much on brute force. Killing bacteria alone is not always the solution.
As for simple antibiotics, they too kill bacteria in the beginning. But in the long run they’re even worse, because the p.acnes bacteria is becoming resistant to them.
The most common antibiotics used by acne patients over the last 30 years are erythromycin, tetracycline, doxycycline, and minocycline. Like any antibiotic they are specially targeted to kill bacteria and originally they killed p.acnes well…
…but both topical and oral antibiotics have been dished out with little restraint. The result is that they increasingly fail to work, especially in Europe and America where usage is heaviest. According to one study, resistance to P. acnes develops in 50% of individuals following treatment with both topical and oral antibiotics.
Furthermore, many antibiotics have side effects. Doxycycline can increase photosensitivity, worsening your skin’s armour against UVB radiation rays from the sun and making your face more prone to free radical damage. That’s bad news; a top priority of all acne patients should be to increase your resistance to UV rays.
Minocycline can do the same, and can also discolour your skin. Antibiotics can make your acne worse and they only kill bacteria in the short term, if that.
They also have side effects inside your body; as well as killing bad bacteria, minocycline can decimate healthy bacterial flora in your gut. A well balanced gut flora is important for brain health, heart disease and many other aspects of health. That includes acne, because healthy bacteria protects your gut lining from foreign substances in food passing through and keeps food allergies at bay. Higher levels of healthy gut bacteria can even enhance your digestion of nutrients from food, including great ones for acne like zinc.
The secret is prevention
For all those reasons, I don’t recommend any of the conventional therapies to kill p.acnes.
Additionally, the entire strategy of focussing on p.acnes alone is flawed. You can reduce the colonies of p.acnes every day with an antibacterial spray, but that’s not a long term solution. You’re only treating a symptom, not the problem itself. The bacteria still has the sebum and low oxygen tension it needs and will keep regenerating.
Instead, you have to eliminate the environment in which p.acnes prospers by unblocking your pores. As we discussed earlier, p.acnes will never multiply beyond perfectly safe and healthy levels your pores aren’t clogged.
Therefore instead of using BP, a better strategy is to boost your vitamin A levels, for example. Vitamin A controls the sebum output of your sebaceous glands; increasing your levels can thus make your skin less oily. Your pores have less sebum in them, and are less blocked overall, so you deprive p.acnes of the conditions it needs to thrive in the first place. You achieve a big reduction in p.acnes without resorting to a face wash every day.
You could also eat less carbohydrates and get the hormone insulin under control, you could take a zinc supplement to lower keratin production and avoid big clumps of dead skin cells, and you could avoid air pollution to prevent your sebum from oxidising.
Not only is killing bacteria with BP every day unnecessary when you can prevent p.acnes overgrowth in the first place, it usually doesn’t work either. It’s nearly impossible to fully suppress p.acnes when so much sebum and so little oxygen present the perfect breeding ground.
Likewise, you can render your p.acnes totally harmless if you get your chronic inflammation under control.
The acne-causing powers of p.acnes are mostly dependent on your immune system’s powerful response to it. Earlier we discussed how the barrage of cytokines and white blood cells kills p.acnes and also causes collateral damage.
Well, such a powerful response only happens when your immune system is chronically overactive, a disease that occurs thanks to chronic inflammation. Chronic inflammation is when your immune system is exposed to so many threats or is so starved of vital nutrition that it cannot control itself, and assaults the slightest threat (like p.acnes) with a full scale war.
For many acne patients, it’s not excessive p.acnes that’s the problem. It’s the fact that everybody’s inflammatory responses to it are so insanely over the top.
Nowadays the average lifestyle is full of inflammation, with diets full of sugary fruit juice and coke, trans-fats, and phthalate chemicals lurking in ready meals. Hence, chronic inflammation is an epidemic that scientists are only just beginning to uncover. Inflammation has been discovered to play roles in heart disease, cancer, dementia (by inflaming brain cells) and particularly chronic joint pain and muscle weakness.
You too might have a wild immune system. In this article, we discussed how it’s one of the two biggest causes of acne.
Why does this matter? Well, if you take steps to lower inflammation in your body, like avoiding sugar, trans-fats, and eating more nutrients that constrain the immune system (like zinc and omega 3s), you can have mild p.acnes overgrowth in your pores but still not have acne. If the attack on p.acnes is mild and controlled then the collateral damage won’t redden and swell the pore up anywhere near as much.
Remember, p.acnes does not cause acne itself. It’s your body’s responses to it that do the damage.
How to ruthlessly stamp out p.acnes
In that case, inhibiting p.acnes is still a good strategy. You need to ignore BP, antibiotics, or any over-the-counter antibacterial treatment. Some excellent ways to kill p.acnes are as follows:
Sweat – despite being falsely believed to clog your pores, sweat is actually great for acne because it contains a peptide called Dermcidin. This has antibacterial properties and studies shows that it kills p.acnes excellently. Dermcidin is more effective than topical antibiotics, yet bacteria cannot develop resistance to it.
Sweat is also terrific at inundating your entire face, compared to a BP cream which you have to apply to every single pore. Exercising, visiting a sauna, or walking around on a hot day are all acne-friendly ways to sweat.
Blue light – out of all the high-tech, scientific acne treatments which could only possibly be available in the modern age, blue light devices are easily the best. The porphyrins in p.acnes cell walls are very sensitive to blue light wavelengths and when exposed, they mutate, generate free radicals, and cause the bacteria to self destruct.
Blue light devices can reduce acne by up to 40% after 4 weeks, solely through killing p.acnes. You can read about the science of blue light for acne here, and the best blue light devices for acne here.
Natural topical treatments – some of my favourites are green tea, aloe vera, tea tree oil, and royal jelly. These all contain a wide array of peptides and antioxidants which kill bacteria, and moreover, they rarely cause the nasty side effects of Benzoyl Peroxide.
Take the example of raw honey. It partially kills p.acnes bacteria by breaking down into hydrogen peroxide upon contact with the skin. HP can cause irritation, but honey also contains many soothing antioxidants so that these problems are cancelled out. For safety, it easily beats one harsh chemical like BP on its own.
Honey has tons of antibacterial compounds, including the famous methylgyloxal, which honeys are assigned a rating based on. There’s also the recently identified bee defensin 1, a peptide manufactured by the bees’ immune systems and added to honey as they create it.
If you want to try it, you should make sure the honey is raw so that the delicate compounds are preserved. Preferably you should buy a bulk tub to save money as well.
A product which fits the bill and which I have used in the past is this Y.S. Eco Bee Farms Raw Honey.
Wash your face with soap – it cannot be emphasised enough that simply washing off excess sebum will stop p.acnes from getting out of control. Sebum is their main food source. You don’t need to scrub every last drop away because your dried out skin will then pump out more sebum to compensate. Simply washing your face with cool (never hot) water and a natural soap, so that the skin no longer feels greasy, will work well.
I use this Dr. Bronner’s Peppermint Liquid Castille Soap soap every day. It’s made from all-natural oils like coconut oil, tea tree oil, and peppermint oil. Unlike commercial soaps or cleansers, Dr Bronner’s is very soothing and not harsh on the skin at all.
Your focus should always be on dietary and lifestyle tactics for acne, but those tricks are a good bonus nevertheless. Directly killing p.acnes can reduce the redness and swelling of acne substantially, if you use the right techniques.
The main thing you have to understand is that simply killing p.acnes day by day, with face scrub after face scrub, will never permanently cure you. It’s not a long-term solution. You’ll never be able to relax one day and just use tap water. As I’ve said elsewhere on this website, you have to tackle acne form the inside out and not the outside in.
The true solution is simple: prevent p.acnes from overgrowing in the first place. Your first focus should be unblocking your pores (article) and curing chronic inflammation (article), and following the nutritional strategies in the articles to accomplish that.
Then you can use the three antibacterial tricks above to control the existing overgrowth, and particularly do some sweating to kill its firmly established bacterial biofilms. After that, p.acnes won’t stand a chance.
Thanks for reading!