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Different Strains Of Acne Bacteria Cause Different Diseases

By Megan Griffith

Reviewed for medical accuracy by Dr. Jaggi Rao,
MD, FRCPC Double board-certified dermatologist

The acne bacterium Propionibacterium acnes, often identified by its abbreviation P. acnes, plays an unusual role in health and disease.

Everyone has billions of P. acnes on their skin. Sometimes this bacterium builds up and clogs a pore, forming a whitehead that later oxidizes on contact with the air into a blackhead. Sometimes the immune system attacks the acne bacteria in a pore and forms a pimple, that can be covered with skin to form a cyst.

Acne Bacteria
Acne bacteria can cause many different types of infections.

Sometimes P. acnes gets into the eyes and causes infections there, and when it is transferred inside the body during a surgical procedure1, it can even induce hardening of the arteries, clog the copper stents heart surgeons implant to keep coronary arteries open, and trigger heart attacks.

Propionibacterium acnes is usually harmless, but sometimes it causes pain and disfigurement of the skin and it can even cause life-threatening health issues. But do you need to worry that if you don’t zap your zits, acne bacteria might rob you of your sight or even trigger a life-ending heart attack?

Recent research tells us the answer to this question is no. Different strains of acne bacteria have different health effects.

Some Strains Of Acne Bacteria Are Actually Beneficial

In a recent study, scientists discovered 143 strains of p. acnes bacteria which fell into eight significant clusters2. It’s true that these bacteria could trade genes through a process of “bacterial sex” called recombination. However, usually each strain of acne bacteria keeps to itself and behaves in relatively predictable ways, and many of them are totally harmless or even beneficial.

Most strains of acne bacteria don’t actually cause acne. These “commensal” bacteria provide a very basic form of skin cleansing that works from the inside out. Living on the sides and in the base of skin pores and around pores on the surface of the skin, they feed on excess skin oil, their numbers reduced by exposure to sunlight and oxygen.

The more oil the skin produces, the more the bacteria are protected from the killing blue light rays of the sun, and the more sebum they can consume. As the bacteria eat up the excess sebum, they are exposed to more sunlight, and their numbers are naturally kept in check.

Some Strains Of Acne Bacteria Cause Eye Infections

The eyes produce lubricating films like tears. Tears are a mixture of proteins, fats, and water, that could accumulate on the eyes except that the excess is consumed by bacteria. Acne genome researchers3 at the Bay Zoltán Nonprofit Ltd. in Szeged, Hungary have announced the mapping of the genome of three genetically unique strains of bacteria that cause eye infections.

Typically, these bacteria cause chronic, mild inflammation of the sclera or “white” of the eyes that is often misdiagnosed as an allergy. A flare-up of the infection on the cornea of the eye, however, can cause sight-threatening keratitis.

Some Strains Of Acne Bacteria Enter The Body With Implanted Medical Devices

Millions of people who have coronary artery disease have their clogged coronary arteries opened with metal stents. These stents are sometimes contaminated with another strain of acne bacteria that produce a wide variety of mild, ambiguous symptoms including confusion, anxiety, dizziness, unexpectedly low blood pressure, unexpectedly high blood pressure, headache, nausea, and fatigue—all of which can also be caused by the surgery. The dyes surgeons use to see the stents during the catheterization procedure tend to “feed” these strains of acne bacteria, but it’s very rare for the infection to become so massive that it actually damages the heart, although infective endocarditis is a real possibility.

Acne bacteria can also hitch a ride on artificial joints4, central lines, and shunts used to relieve pressure. As with infections on implanted devices in the coronary arteries, infections on these medical devices usually cause a variety of vague symptoms that are aggravated by the dyes used to make the images used to examine the damage.

And Acne Bacteria Can Cause Many Other Kinds Of Infections

There are a number of other manifestations of infection with acne bacteria. Here are just a few of the signs and symptoms5:

  • Painful infections of the muscles after rotator cuff surgery.
  • Primary biliary cirrhosis, destruction of the tissue around and in the bile duct that drains the liver, mimicking gallbladder disease.
  • Fevers and chills after blood transfusions.
  • Triggering rheumatoid arthritis, in both children and in the elderly,
  • Severe joint pain.
  • Gum disease and even
  • Bad breath.

Any and all of these conditions can be caused by acne bacteria. But what difference does that make in day to day health care?

Why You Need To Know About Different Kinds Of Infections Caused By Acne Bacteria

The reason you need to know that there are many different kinds of infections caused by acne bacteria is that chances are that your doctor won’t. Moreover, some of the kinds of tests that doctors routinely run when the symptoms become serious can actually make the underlying disease worse.

If you are scheduled for elective surgery on your heart, your joints, your gums, or your eyes, make sure that your acne is in good control. Ask your doctor about appropriate antibiotics6.

Even though the strains of acne bacteria that cause acne symptoms are not the same strains that cause so many serious problems in the eyes, in the mouth, and in the interior of the body, they live alongside other strains of bacteria in the pores. Ironically, your acne treatment program might save you a stay in the hospital with a heart or liver problem.

And if you develop a diagnosed Propionibacterium infection in some part of your body other than your skin, don’t be hesitant to ask questions about the antibiotics your doctor prescribes. Antibiotics that are not effective for skin infections may not work for infections inside your body, either.

Don’t be afraid to ask your doctor to explain how it is that you are getting the treatment you need, and take the entire, prescribed amount. Don’t give destructive strains of acne bacteria a chance7 to come back.


  1. Achermann Y., Goldstein E.J., Coenye T., Shirtliff M.E. Propionibacterium acnes: from Commensal to Opportunistic Biofilm-Associated Implant Pathogen. Journal of Bacteriology. 2012;194(6):1621-2.
  2. Lomholt H., Kilian M. Population genetic analysis of Propionibacterium acnes identifies a subpopulation and epidemic clones associated with acne. PLoS One. 2010;5(8):e12277.
  3. Vörös A., Horváth B., Hunyadkürti J., McDowell A., Barnard E., Patrick S., Nagy I. Complete Genome Sequences of Three Propionibacterium acnes Isolates from the Type IA2 Cluster. Dermatology Research and Practice. 2012.
  4. Zeller V., Ghorbani A., Strady C., Leonard P., Mamoudy P., Desplaces N. Propionibacterium acnes: an agent of prosthetic joint infection and colonization. The Journal of Infection. 2007;55(2):119-24.
  5. Millett P.J., Yen Y.M., Price C.S., Horan M.P., van der Meijden O.A., Elser F. Propionobacter acnes Infection as an Occult Cause of Postoperative Shoulder Pain: A Case Series. Clinical Orthopaedics and Related Research. 2011;469(10):2824-30.
  6. Piggott D.A., Higgins Y.M., Melia M.T., Ellis B., Carroll K.C., McFarland E.G., Auwaerter P.G. Characteristics and Treatment Outcomes of Propionibacterium acnes Prosthetic Shoulder Infections in Adults. Open Forum Infectious Diseases. 2015;3(1):ofv191.
  7. Saper D., Capiro N., Ma R., Li X. Management of Propionibacterium acnes infection after shoulder surgery. Current Reviews in Musculoskeletal Medicine. 2015;8(1):67-74.
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