INTRODUCTION
The skin is colonized by commensal skin microbes that live in homeostasis with the host to form a resident microbiome, and temporarily live on the skin pathogen microbes from the environment, which form the transient microbiome.1
In acne skin, the resident microbiome contains Cutibacterium acnes and Staphylococcus epidermidis, while the transient microbiome includes Staphylococcus aureus.2 A microbial imbalance can be one of the major factors in the pathophysiology of acne.3
Acne can be caused by hormonal changes in the organism, such as hypothyroidism, hyperthyroidism, or polycystic ovary syndrome (PCOS).4 Main hormones that are responsible for acne formation are testosterone, androstenedione, dihydrotestosterone, and estrogens.5 Malfunctions of the endocrine system can lead to increased sebum production caused by excessive work of sebaceous glands, which results in clogging ducts that drain secretion outside, resulting in the appearance of nodes and spots. Disorders in the exocrine system can be induced by prolonged exposure to excessive stress, incorrect skin care, consuming stimulants, and genetic predisposition.6
The skin constitutes an essential protective barrier from pathogens, which plays an important role in body temperature regulation and vital senses; therefore, it is crucial to maintain healthy skin in any conditions.7
Novel Methods in Acne Treatment
Oxidative stress and inflammation are factors considered to be involved in the etiopathogenesis of acne. Research shows that supplements with silymarin, N-acetylcysteine, and selenium visibly reduce inflammation lesions in patients with acne by reducing oxidative stress. Glutathione is negatively correlated, whereas malondialdehyde and interleukin-8 are positively correlated with clinical characteristics of acne. Treating acne patients with oral antioxidants such as doxycycline8 or topical antioxidants such as azelaic acid can help reduce acne lesions.9 Studies have shown that a diet rich in antioxidants such as zinc,10 probiotics,11 and fish oil12 may improve the effects of acne treatment.
Photodynamic therapy can help regulate bacterial flora as a non-invasive, fast, and effective alternative.13-14 Research has shown that laser therapy indicates a selective cytotoxic effect on Propionibacterium acnes.15 Blue-light is often used to treat acne because the porphyrins have peak absorption at blue-light wavelength.16 Red light allows deeper penetration into the skin, but can cause many adverse effects such as erythema, crusting, pigmentation, edema, and pustular eruptions.17 Laser therapies can also be directed at damaging sebaceous glands by reducing their size and sebum production.18 These therapies use infrared laser, low-energy pulsed-dye lasers, and radiofrequency.19 Laser therapy treatment of acne has become more popular, although it is recommended that further research be performed on this. Each patient should be treated individually according to the severity and toleration of each method.20 Phototherapy should be used only in severe cases of acne that are resistant to
