Cutibacterium acnes-induced Facial Granulomas Associated with the Clinical Course of Distinct Dental Infections: A Case Report

Abstract

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.