Using Viruses to Treat Acne- the Next Big Thing?

Aidan Wong

Viruses are well known for being microscopic, invisible killing machines that infect every type of living organism. The recent pandemic, which saw SARS-CoV-2 claim millions of lives worldwide, is a prime example of this.

But perhaps less well known are many of the weird and wonderful things we have begun to use them for as scientists have gained a greater understanding of how these small, infective agents work. Among them, treating acne, of all things- a fact all but a fortunate few teenagers will be all too familiar with.

Though the surface of your skin itself is made up of dead skin cells, it harbors a rich ecosystem of largely harmless bacteria and other microorganisms, collectively known as the microbiome. Your gut also harbors a similar microbiome, which aids in digestion, maintaining good gut health and a robust immune system. Similarly, the microbiome on your skin plays many roles. Superficially, it is involved in maintaining ‘clear skin’, but on a deeper level it’s also important for maintaining pH and outcompeting any potentially harmful bacteria that may emerge.

Existing acne treatments, while effective enough, take a broad approach to treating acne. Antibiotics are used for the most severe of cases, and most often take the form of creams, gels and pills. Whilst they do get the job done, this comes at a cost. Similarly to how chemotherapy kills both healthy and cancerous cells, antibiotics fail to make the distinction between ‘good’ harmless bacteria and ‘bad’ acne, causing bacteria such as C. acnes. Both are killed, which disrupts the balance of your skin’s microbiome, leading to other problems.

All viruses are highly specific in terms of the cells they infect. Bacteriophages are viruses that infect specific strains of bacteria, sometimes killing them, and sometimes influencing their metabolism in more subtle ways. One such bacteriophage, PAD20, was found to be effective at killing C. acnes whilst leaving other non-acne-causing strains, and therefore the skin microbiome, intact. This is a key advantage of this alternative treatment.

However, strains of C. acnes that were able to modify their own DNA or had high rates of mutation were found able to evade death at the hands of PAD20- basically the phage version of antibiotic resistance. Bacteriophage treatment, therefore, might not work all the time. It is also likely to be an expensive treatment given its novel and experimental nature, and therefore not accessible to most of the population. These are credible arguments against their use and development, and makes one think we might be better off using the antibiotics we currently have.

However, antibiotic resistance is on the rise because of our careless overuse of antibiotics in recent years. As a result, the effectiveness of conventional treatments is likely to decline, forcing us to turn to alternate treatment options such as phage therapy. That said, phage therapy has a long way to go before it becomes a commercially and medically viable option. It seems, at least for now, we’ll have to stick with what we have.

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