[Skin reactions to antigens of propionibacterium acnes in patients with acne vulgaris treated with autovaccine].

One of the most common diseases of the skin is acne. The etiology and pathogenesis of acne, in spite of the advancement of medical knowledge, remain unknown and the effects of treatment unsatisfactory. The mechanism of the beneficial effects of immunotherapy in some cases of acne, including autovaccines prepared from the bacterial strains of the patient, also awaits explanation. The present work was aimed at elucidating the influence of autovaccine on some parameters of specific humoral and cellular response against the same strains of Propionibacterium acnes that were isolated from the patient to prepare the autovaccine. These parameters were evaluated in vivo on the basis of early and delayed skin reactions and in vitro using respective laboratory tests. By analysing the influence of autovaccine on the immunological status it was hoped to shed some light on the immunological aspects of acne. An improvement after autovaccine was noted in 47.6% of patients. At the same time it was observed that the results of the present treatment with autovaccine were much better in patients who were previously treated for acne with Acnevac or autovaccine than in other patients. One may therefore conclude that repeated immunotherapy in acne is advantageous in terms of results. The frequency of early skin reactions against the Propionibacterium acnes of the patient and against standard strains, the level of serum IgE antibodies in patients with acne of various intensity and the release of histamine in the presence of Propionibacterium acnes from basophils of patients with positive early skin reactions all stand against the role of early-type hypersensitivity and anaphilactoid phenomena linked with the structural antigens of the patient's strains of Propionibacterium acnes in the pathogenesis of acne (Tab. 1, Fig. 1). Reactions reflecting delayed-type hypersensitivity against the patient's strains of Propionibacterium acnes were observed more frequently than early-type reactions and more frequently than against standard strains (Tab. 2). Clinical improvement was particularly evident in patients in whom the intensity of the reactions decreased after treatment. This was accompanied by higher titres of specific antibodies against structural antigens of Propionibacterium acnes (Tab. 3) and a greater inhibition of migration of mononuclear cells in the presence of these bacteria or a nonspecific mitogen (PHA). It was concluded that specific antibodies generated by the autovaccine and directed against the strain of Propionibacterium acnes of the patient may reduce the intensity of delayed-type reactions in some cases of acne, as previously reported for tularemia and tuberculosis. Final unequivocal conclusions as to the pathogenesis of acne and mechanism of the effects of autovaccine could not be drawn. However, the present results form an encouraging basis for further research in this field.