Acneiform eruptions are skin diseases that mimic acne vulgaris but lacking typical follicular blockage features. Acne vulgaris and some granulomatous variants of acneiform eruptions can involve Cutibacterium acnes, an anaerobic opportunistic bacterium; however, some cases remain resistant to standard antibiotics treatments. We report a 56-year-old male with facial acneiform granulomas unresponsive to long-term antibiotic and steroid treatments. The patient had no history of additional medications or other diseases, except symptomatic apical periodontitis in a molar toot. Both facial skin and dental lesions shared a key finding, intracellular infection of C. acnes within macrophages, despite differing histopathological features. The facial acneiform eruptions did not respond to initial minocycline treatment. However, following extraction of the infected tooth, the facial granuloma responded to the antibiotics and resolved without complications. PCR analysis confirmed C. acnes DNA in both the dental and skin biopsies. This case indicates the C. acnes-associated oral-skin-microbiome axis although a direct causal link between the distinct lesions could not be fully established. Odontogenic infection may act as reservoirs, impairing efficacy of antibiotic treatment. We recommend dental evaluation for case of facial acneiform granulomas that do not respond to antibiotics alone.

• 한다울(연세대학교 치과대학 구강병리학교실) | Dawool Han (Department of Oral Pathology, Oral Cancer Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemoon-Gu, Seoul, 03722, Repulic of Korea)
• 송상현(연세대학교 치과대학 구강악안면외과학교실) | Sang Hyun Song (Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemoon-Gu, Seoul, 03722, Repulic of Korea)
• 한승용(연세대학교 치과대학 구강병리학교실) | Seung Yong Han (Department of Oral Pathology, Oral Cancer Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemoon-Gu, Seoul, 03722, Repulic of Korea)
• 조나영(연세대학교 치과대학 구강병리학교실, 연세대학교 치과대학 K21 FOUR Project) | Na Yeong Cho (Department of Oral Pathology, Oral Cancer Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemoon-Gu, Seoul, 03722, Repulic of Korea, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemoon-Gu, Seoul, 03722, Repulic of Korea)
• 육종인(연세대학교 치과대학 구강병리학교실, 연세대학교 치과대학 K21 FOUR Project) | Jong In Yook (Department of Oral Pathology, Oral Cancer Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemoon-Gu, Seoul, 03722, Repulic of Korea, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemoon-Gu, Seoul, 03722, Repulic of Korea)
• 이중석(연세대학교 치과대학 치주과학교실) | Jung Seok Lee (Department of Periodontology, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemoon-Gu, Seoul, 03722, Repulic of Korea)
• 조은애산드라(연세대학교 치과대학 구강병리학교실, 연세대학교 치과대학 K21 FOUR Project, 기초과학연구원 유전체 교정 연구단) | Eunae Sandra Cho (Department of Oral Pathology, Oral Cancer Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemoon-Gu, Seoul, 03722, Repulic of Korea, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemoon-Gu, Seoul, 03722, Repulic of Korea, Center for Genome Engineering, Institute for Basic Science, 55 Expo-ro, Yuseong-gu, Daejeon, 34126, Repulic of Korea) Corresponding author