A microbial etiology of acne?

The view is advanced that sebum as originally produced must contain materials, other than lipids, which may serve as a selective substrate for growth of bacteria and yeasts. Growth of large numbers of P. acnes and P. granulosum in some follicles is considered to place those follicles at risk of undergoing pathological changes. Deleterious products of bacterial growth could be not only lipase and free fatty acids, but also other enzymes as well as bacterial antigens and unspecified toxins or irritants. The possibility is suggested that follicles heavily infested with P. acnes and P. granulosum may be identified by their reddish fluorescence under ultraviolet light, thus permitting identification and study of those which are at risk. Antibiotics may be helpful in reducing the formation of harmful bacterial products during continued growth of the organisms. The eventually self-limiting nature of the disease may be due to the immune response to bacterial products, or to an accommodation of the follicular epithelium to the long-continued presence of irritant materials within the follicle.