Acne and sciatica are rarely spoken about in the same breath. One is considered a curse of youth, the other of age. But scientists in Birmingham are now actively pursuing a connection between the two. The theory is that people who get acne might be predisposed to sciatica in later life, and the long-term consequences for many thousands of sciatica sufferers could be profound. Instead of their pain being simply contained by anti-inflammatory drugs, it could be treated by a course of antibiotics - tablets targeted at a bacteria called probionibacterium acnes.
As the second part of that name suggests, the bacteria has hitherto been found emblazoned on burning cheeks and foreheads. Its discovery lurking at the base of sciatic spines came about, as so often with medical breakthroughs, quite by chance and in an unlikely setting.
The department of pathology at the Queen Elizabeth hospital in Birmingham hardly looks like a building at the cutting edge of medical science. In fact, it looks like a wooden shack. Beyond its deceptively small exterior, though, it opens out, Tardis-like, into a labyrinth of shabby corridors. Down one of them is the office of Professor Tom Elliott, consultant microbiologist, director of clinical laboratory services and a world leader in research into catheter-related infections in hospital patients, together with his colleague, Dr Peter Lambert, reader in pharmaceutical sciences at Aston University.
Eighteen months ago, the pair started developing blood tests to diagnose deep-seated infections in the spine. They needed a control group to provide a comparison with their own patients. Some 140 sciatica sufferers were duly supplied by Alistair Stirling, a surgeon at the nearby Royal Orthopaedic hospital. "We expected them to provide negative results," Elliott says. "But, to our astonishment, 50% proved positive. We thought there must have been a mistake. Some cross-reaction in the blood tests, perhaps. So we did them all again and got the same result. Was there an organism in there? Could it be true?"
Once again they prevailed on Stirling. This time he supplied tissue from his operations on patients with sciatica. "Nobody had ever cultured it before," El liott says. "We incubated the tissue on a plate and kept looking every day. Nothing. It was agonising. Normally something would show up after 48 hours, but I still had a suspicion something was there. I was prepared to wait three weeks if necessary. As it happened, it took seven days before pinpoint colonies of bacteria were spotted."
A eureka moment then?
"That came later when we carried out tests on tissue from another 36 patients and produced the same result."
Proof of the presence of the bacterium in the spine is one thing, but how did it get there in the first place? And what is the connection with acne?
"We know that people who are prone to sciatica can get initial attacks while in their 20s and 30s," says Elliott. "That could be as a result of a sporting injury sustained in the teens. Those with severe acne can all too easily scratch, squeeze or nick their spots, breaking small blood vessels and allowing organisms into the blood stream. The body has natural defence mechanisms to kill these foreign bodies. But some may manage to evade the defences. They're likely to see a damaged spine as a nice place to hide in and colonise."
Which would be all very well if the organisms simply laid low. Unfortunately, they have a habit of producing enzymes which can damage tissue around the infection. That may result in the disc becoming protruded and putting pressure on the nerve roots.
Since the Lancet published the results of their initial research, Elliott and Lambert have been inundated with emails, letters and phone calls from both sides of the Atlantic. The majority have come from specialists in back pain, none at all from dermatologists.
None the less, the next stage of the Birmingham scientists' project will be an epidemiological study into the unlikely link they've forged between skin and spine. Could any resulting antibiotic be helpful to those with acne as well as sufferers from sciatica?
Probably not, says Elliott. "The main emphasis of our work will continue to be on the disc rather than the face."
While we wait for further results, acne sufferers might do well to take note that squeezing those spots could be doing damage in the long term. And not just to your complexion.
