# _Cutibacterium acnes_ Dysbiosis: Alternative Therapeutics for Clinical Application
## 2 New Therapeutic Strategies
However, no significant difference was observed in the treatment and in the vehicle lotion in the improvement of AV [31]. [PERSON] et al. applied a base cream including heat-killed _L. plantarum_-GMNL6 on one side of the face in 15 females. The treatment significantly reduced the amount of _C. acnes_ and reduced, inclusively, the red areas and the porphyrin [32]. [PERSON] et al. performed a microbiome transplantation of beneficial strains of _C. acnes_ to the patient's skin. The results were not statistically significant but clinical improvements in the noninflammatory lesions were observed. The major limitation of the study was the absence of a control or placebo group and the small participant sample, highlighting the need for further studies with larger groups to correlate the microbiome transplantation with beneficial outcome in AV patients [33]. More recently, phage therapy has been increasingly studied as an innovative approach in bacterial infection treatments. Phage therapy, short for bacteriophage therapy, is a type of treatment that uses bacteriophages to target and kill specific bacteria (Figure 2). Bacteriophages, often referred to as phages, are viruses that infect and replicate within bacteria, ultimately leading to the bacterial cell's death [34]. This way, phage therapy constitutes a potential approach for treating bacterial infections, including those caused by bacteria like _C. acnes_, and involves identifying and isolating specific bacteriophages that can target and infect _C. acnes_ bacteria. Once suitable phages are isolated, they can be purified and used to treat the infection [35]. The phages attach to the surface of _C. acnes_ bacteria, inject their genetic material, and then replicate inside the bacterial cell. This replication ultimately leads to the lysis (bursting) of the bacterial cell, killing it, and releasing more phages to attack other bacteria [35]. Figure 2: Phage isolation: phages can be collected from water center treatments, hospital facilities, lakes, and human samples. Afterwards, these phages are isolated and tested against different bacterial strains to assess the phages’ antimicrobial potential in specific strains. This specificity promotes a personalized therapy, as it allows it to be applied according to the patient’s specific microbiome. After proper analysis and validation, the phages of interest can be tested for different applications, such as antimicrobial drugs, drug delivery systems, and topical creams, for example. Phase therapy entails several advantages, such as (a) specificity, as phages are highly specific to the target bacteria, reducing the risk of harming beneficial bacteria in the body; (b) reduced antibiotic resistance, since phages can be effective against bacteria with multiresistant profile and help overcome virulence mechanisms such as the production of biofilms; and (c) potential for personalized treatment, since it constitutes a therapy that can be tailored to a specific strain that is causing infection [28; 34]. This therapy has been considered an optimistic possibility to provide specific treatment in infections with pathogenic bacteria and in dysbiosis conditions when compared to the use of antibiotics [28]. As such, several studies have been conducted, using phages as the vehicle to treat _C. acnes_ bacterial infection. [PERSON] et al. recovered isolates of _C. acnes_, among other strains, from facial abscesses of patients with severe AV. The group succeeded in the isolation of a phage, Y3Z, recovered from the sewage samples, compatible with the strains mentioned, with the ability to perform lysis in all the bacterial isolated from the lesions, showing suitable properties for phage display applications [34]. [PERSON] et al. isolated 15 new _C. acnes_ phages from patients with AV and tested them on clinical isolated strains of _C. acnes_. The results showed that very few of the pathological strains were susceptible to specific phages in the in vitro assays.