Cutibacterium acnes

Yes.

The dominant pathogen we worry about here is cuta bacterium acnes, or C. acnes.

It is an anaerobic gram-positive bacillus, and its natural habitat is deep within the pyelisophate's unit.

The sebaceous glands and the hair follicles of the skin.

So the sleeper agent infiltrates the base during the initial supposedly sterile operation.

But why doesn't the patient's immune system immediately clear it or at least mount a massive response that we would notice in the first few weeks in clinic?

Because C. acnes is incredibly indolent, and it is just an evolutionary master of evasion.

How so? Well, once it is introduced into the joint space, it adheres to the metal and the polyethylene components of the prosthesis.

And then what happens is we have retention hyperkeratosis, where It creates this plug in the follicle and then the oxygen levels start to drop.

Well, once that oxygen level drops, then the C. acnes bacteria then starts to thrive.

It starts breaking down the C. bump.

which then creates something called free fatty acids.

We're going to see the area get a little bit irritated and swollen, maybe inflamed, but it is an immune response.

It is not considered an infection.

It is actually considered a very sterile environment within that plug because the C. acnes bacteria is in there with like a lower oxygen environment and sebum.

And that's what's happening.

Typically, when you're doing blue light treatments, you're going to sit in front of a blue light lamp for about 15 minutes, maybe two sessions per week, generally like a four-week period.

Blue light kills the acne-causing bacteria known as Propionibacterium acnes, or P. acnes, which causes inflammation and junks up the sebaceous glands with the bacteria that then cause cystic type of acne.

Cysts and nodules and bacteria levels can improve dramatically.

LED blue light can also improve healing as far as third degree skin burns and is so useful for improving inflammatory side effects of acne.

So you take a swab behind the ear and you measure the level of actinobacteria.

We specifically measure something called P. acnes if that's present in patients.

So all that to say, it's an area we're still learning and This is something that Dr. Shoemaker is now spending a lot of his time and attention on, better understanding that.

How old is Dr. Shoemaker? He's in his early 70s now.