<![CDATA[Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit commonly affecting adolescents and young adults. Recent studies suggested that acne is associated not only with the abundance of C. acnes but also with dysbiosis of the skin microbiome and the predominance of more proinflammatory bacterial strains. The study aimed to discuss both the role of the skin microbiome and C. acnes in the pathogenesis of acne vulgaris. A literature review using the PubMed database using keywords such as “skin microbiome”, “inflammation”, and “Cutibacterium acnes”. Studies published within the last five years were included. Studies were reviewed based on titles, abstracts, and full text. Data from four studies were analyzed, obtained, and categorized based on the normal microbiome composition, dysbiosis, strain differences, inflammatory mechanism, and therapeutic implications. The findings indicated that acne vulgaris is associated with skin microbiome dysbiosis due to reduced microbial diversity and the predominance of specific C. acnes strains, including RT4, RT5, RT8, and RT10. These strains demonstrated the ability to form biofilms, produce virulence factors, and activate inflammatory pathways by increasing proinflammatory cytokines. Conventional therapies have not fully targeted microbiome balance, leading to the emergence of new approaches. In conclusion, the pathogenesis of acne vulgaris is influenced by the presence of C. acnes, imbalance of the skin microbiome, and the predominance of more virulent strains.]]>
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