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.

The purpose of this study was to investigate the antimicrobial activity of the ethanol extract of Garcinia mangostana L. (mangosteen) against Cutibacterium acnes (6 strains) and Staphylococcus aureus (6 strains). The antimicrobial activity of the mangosteen extract was evaluated based on its minimal bactericidal concentration. Cytotoxicity of the mangosteen extract against human embryonic kidney 293 (HEK 293) cells was determined using the cell counting method. The data showed that the mangosteen extract was not toxic to HEK 293 cells at a concentration of up to 16 μg/mL and killed 87.0% and 99.9% of C. acnes and S. aureus after 10 minutes and 1 hour of treatment, respectively. These results suggest that ethanol extract of mangosteen can be used as an anti-acne agent.