The Sunday Times 7 April 2013
Until now, spots have been squeezed out by wrinkles in the league table of skin issues to worry about. There are more people getting old than there are getting spots, so big investment has focused on the hunt for optimum treatments to preserve the looks of the affluent and elderly, while the problems of the under-30s — whether it is occasional outbreaks of pimples or rampant acne — have largely been ignored.
Since the 1980s, doctors have offered spot-sufferers antibiotics, the contraceptive pill or, for those severely afflicted, a variety of potent drugs derived from vitamin A, even though none of these approaches has ever really worked. Skincare companies, meanwhile, assumed drugs had taken care of the worst of the disfiguring problems of youth, so concentrated on marketing new formulations of medicated camouflage creams, which also have limited efficacy.
All that could be set to change with the breakthrough discovery of a natural virus called a phage, already living on the skin, that can selectively target and kill the spot-causing bacteria. This is a pathfinding approach that could eliminate the problem overnight, and a battle is under way to develop the first cream to contain the phage. It could be on the market within two years. “Acne is a common disease that is psychologically devastating for people affected by it,” says Jenny Kim, a dermatologist at the UCLA centre for aesthetic medicine and one of the leaders of the phage research.
It could not have happened at a better time: skin specialists have reported that acne is erupting afresh as a result of the global spread of antibiotic-resistant superbugs. In Britain, at least one in four cases is caused by a new, resistant strain ofPropionibacterium acnes, the spot-causing bug, and in some parts of southern Europe, resistant bacteria cause most cases of acne, so antibiotics no longer work at all.
For most teenagers, looking in the mirror and seeing the velvety skin of childhood replaced by a greasy mask is distressing enough. A sprinkling of spots on top is the last straw, but most adolescents — regardless of race — get some spots as a result of increased grease or sebum production, triggered by the hormones of puberty. Skin pores get blocked with grease and dead skin. These pores are then colonised almost exclusively by this one grease-loving organism, P acnes. The bacteria set up infection and inflammation as they feed on the grease and dead skin.
One in three teenagers suffers from severe acne, with rashes of spots on their faces, necks and backs. Some people, especially women, continue to suffer for most of their lives, and may be left with permanent skin blotches and “ice pick” indented scars on their faces. It is remarkable that, in the 21st century, a cure has still not been found for this common condition. It was researchers from Kim’s laboratory at UCLA, in collaboration with the University of Pittsburgh, who came up with the new solution. They discovered a specific phage that can “infect” P acnes with a protein called endolysin, which then kills the bacterium by breaking down its cell walls.
In contrast to “broad spectrum” antibiotics, phages can be directed at specific bacteria, and because they can be put into a skin cream, rather than swallowed, the team hope their innovation will be fast-tracked through the regulatory process.
“Phages are natural — we don’t have to manufacture them in a laboratory — so we’re hoping it will make the clinical trials easier,” Kim says. “Other scientists have started to get interested, because we have something that looks as if it might work and might also be effective for other infections. Antibiotic resistance is a real problem and we think this is a way of dealing with it.”
Her fellow phage expert Graham Hatfull, professor of biotechnology at the University of Pittsburgh, is equally upbeat. “We think this will work because it will destroy the target bacteria specifically, and we don’t think there will be serious safety concerns, because these phages are all around us in the environment,” he says. “Phages have long been used as an alternative to antibiotics for all sorts of conditions in the former Soviet Union and countries in eastern Europe, but because little is known about them in the West, they are regarded with suspicion.”
In fact, phages are already used as an alternative to antibiotics in food production, but British skin experts remain sceptical. The consultant dermatologist Dr Alison Layton, one of Britain’s leading acne experts, agrees there is an urgent need for an alternative to antibiotics, but says: “We think acne begins before P acnes even colonises the skin. I am not at all sure this approach is going to work.”
She believes a better prospect for spot treatment lies in the development of lasers that target the fluorescence produced by P acnes and destroy the bacteria, as well as reducing grease production. Yet the science remains in its infancy: the treatment has to be repeated at two-monthly intervals and costs thousands of pounds. Kim believes that, with any luck, phage treatment will wipe out the spots first.
What can you do in the meantime?
A bleaching agent used for hair dye and tooth whitening, it works as a peeling agent on the skin. It increases skin turnover, clearing pores and reducing the P acnes bacterial count, as well as acting directly as an antimicrobial. It can cause drying and irritation, and may increase cancer risk.
This ancient anti-inflammatory, derived, like aspirin, from willow bark, also clears away dead skin cells.
A tablet, derived from Vitamin A and marketed as Roaccutane, that, taken daily over four to six months, can get rid of acne. It is believed that it works primarily by reducing the secretion of oils from the glands. Has been linked to depression.
Usually tetracycline. May not work and should not be taken long-term.
May work if spots are related to hormone production during the menstrual cycle.