08 April 2020
You might already be familiar with the benefits of probiotics for gut health, thanks to Yakult, the probiotic containing Yoghurt drink from our childhood. Probiotics can be thought of as ‘good bacteria’ that help with a variety of conditions like digestion when taken as drinks or supplements; and may have a role in reducing inflammation in the skin when used topically in skincare.
Although probiotics was one of the break out ingredients in the skincare scene of 2019, skin care products containing probiotics have been around for years now. Probiotics, prebiotics, postbiotics and microbiome (confused or still following me?) look set to continue to make a strong presence in dermatology in 2020, judging by the plethora of skincare products that have joined the foray of microbiome beauty products.
Today’s review will take you through understanding probiotics and microbiome skincare and supplements; the science and safety behind the hype- and then you can decide for yourself if these bugs get under your skin. Enjoy!
But first, a background on these bugs:
The human skin is teeming with over 1000 species of bacteria1 with one million of these mico-organisms per square centimetre of the skin2. If this grosses out the germaphobe in you, hold on before you reach for your sanitiser. These bacteria are part of the skin’s natural microenvironment called microbiome. These bacteria generally do not harm us and our skin and have an important role in keeping our skin healthy and disease free in a complex interplay of dynamics.
he bacteria on our skin are also known as commensal bacteria. Commensal bacteria on the skin keep our skin’s balance in check by3,4:
• Preventing harmful bacteria from colonising the skin’s surface
• Defend against disease causing bacteria
• Promote immune tolerate and reduce the severity of inflammatory disease
• Regulate skin pH
A loss of this delicate balance between commensals and harmful bacteria on the skin has been linked to disorders of the skin such as acne, eczema, psoriasis and rosacea5-7.
Not all the mechanisms have been fully elucidated to date, but the science so far shows that microbes protect the skin in a steady state by directly blocking harmful bacteria from colonising the skin. Commensal bacteria also regulate our body’s immune system to enhance defense against harmful bacteria while reducing inflammation by secreting antimicrobial factors5-9.
Some bacteria may do more than merely increasing the skin’s defense against harmful pathogens. Streptococcus thermophilus has been shown in small studies to increase the level of ceramides in the skin10-12; making this a promising area of further research for patients who have sensitive skin and eczema.
Probiotics creams and serums contain live strains of bacteria to increase the skin’s population of ‘good’ bacteria to increase the benefits of these ‘good’ bacteria.
The skincare and medical jargon may be a little confusing so allow me to break it down for you.
• Probiotics are live strains of bacteria that benefit the skin
• Prebiotics are the ‘food’ that the probiotics feed on
• Postbiotics are the metabolites or by-products released by probiotics
Even though probiotic skincare products are in vogue right now, the science for microbiome skincare is still in its infancy stages. Most of the studies and data are based on small studies and don’t replace mainstream treatments such as lasers and chemical peels for acne or Botox or Rejuran Healer for anti-aging and skin rejuvenation.
This is what the science shows so far for applying probiotic skincare:
• Acne: Small studies have show an improvement in acne and reduced bacterial load of P acne13,14.
• Sensitive and dry skin: Probiotics containing Streptococcus thermophiles applied to the skin have shown to increase ceramide levels in the skin in a few studies10-12.
• Eczema (astopic dermatitis): Early research into probiotic skincare for eczema has shown some benefits with topical probiotics11,19.
• Wound healing: Topical probiotics may improve wound healing and reduce inflammation20,21. Some probiotics may also improve wound healing by reducing skin infections22,23.
• Anti-aging: Some studies show that some bacteria can help to quench free radicals which accelerate aging24,25.
The lining of the gastrointestinal tract also has its own microenvironment of bacteria, just like the skin. A loss of this balance between commensal bacteria and harmful bacteria has been linked to skin disorders such as rosacea26. One study showed remission of rosacea after the gastrointestinal microflora was restored to normal26.
The use of oral probiotics to indirectly influence skin diseases has also been explored in several studies. Here’s what some of the research show:
• Acne: Oral probiotics containing Lactobacillus species improved acne after 12 weeks and had greater effectiveness when combined with antibiotics27,28.
• Eczema (atopic dermatitis): The effects of oral probiotics has been studied most extensively in eczema. Although there are studies that support the use of oral probiotics for treating eczema29,30, a Cochrane review of 39 randomised controlled trials up to 2017 showed that oral probiotics made little or no improvement in reducing the symptoms of eczema and concluded that use of probiotics for the treatment of eczema is currently not evidence-based31.
Probiotic skincare may be trending right now but our understanding of the science of probiotics is still incomplete. Suffice to say, probiotic skincare isn’t going to replace tried and tested treatments and skincare active ingredients anytime soon. If you’re still considering trying out probiotic skincare, please check in with your doctor especially if you have specific skin conditions such as acne and rosacea. The balance of ‘good’ and ‘bad’ bacteria is a delicate one and so far our knowledge about probiotics has been limited to specific species and strains.
Oral probiotic supplements and drinks seem to be more promising for treating skin conditions on top of improving gut health. If I had to recommend oral probiotics versus probiotic skincare for general skin health, I’d say oral probiotics would be my choice. If you have acne, I’d say it’s worth a try.
Hope you found this review on probiotics and the skin useful. Have a good week!
1. Topographical and Temporal Diversity of the Human Skin Microbiome. Grice et al. Science. 2009 May 29; 324(5931): 1190–1192.
2. Topical use of probiotics: The natural balance. Tavaria. Porto Biomedical Journal. 2017 May-June; 2(3): 69-70.
3. Activation of TLR2 by a small molecule produced by Staphylococcus epidermidis increases antimicrobial defense against bacterial skin infections. Lai et al J Invest Dermatol 2010;130:2211–21.12
4. Commensal bacteria regulate Toll-like receptor 3-dependent inflammation after skin injury.Lai et al. Nat Med 2009; 15:1377–82.
5. Microbiome and skin diseases. Zeeuwen et al. Current Opinion in Allergy and Clinical Immunology. 13(5):514–520
6. Skin barrier and microbiome in acne. Rocha and Bagatin. Arch Dermatol Res. 2018 Apr;310(3):181-185.
7. Changing our microbiome: probiotics in dermatology. Yu et al. Br J Dermatol. 2020 Jan;182(1):39-46.
8. Impact of prebiotics and probiotics on skin health. Al-Ghazzewi and Tester. Benef Microbes 2014;5:99–107
9. Pre- and probiotics for human skin. Krutmann. Clin Plast Surg 2012;39:59–64.
10. Increase of skin-ceramide levels in aged subjects following a short-term topical application of bacterial sphingomyelinase from Streptococcus thermophilus. Marzio et al. Int J Immunopathol Pharmacol. 2008 Jan-Mar;21(1):137-43.
11. Effect of the lactic acid bacterium Streptococcus thermophilus on stratum corneum ceramide levels and signs and symptoms of atopic dermatitis patients. Marzio et al. Exp Dermatol. 2003 Oct;12(5):615-20.
12. Effect of the lactic acid bacterium Streptococcus thermophilus on ceramide levels in human keratinocyte in vitro and stratum corneum in vivo. Di Marzio et al. J Invest Dermatol. 1999;133:98–106.
13. Antimicrobial activity of enterocins from Enterococcus faecalis SL-5 against Propionibacterium acnes, the causative agent in acne vulgaris and its therapeutic effect. Kang et al. J Microbiol. 2009;41:101–109.
14. Pilot study on novel skincare method by augmentation with Staphylococcus epidermidis, an autologous skin microbe–a blinded randomized clinical trial.J Dermatol Sci 2015;79:119–26.
15. The role of the skin microbiome in atopic dermatitis. Williams and Gallo. Curr Allergy Asthma Rep 2015;15:65.
16. The role of the skin micro-biome in atopic dermatitis: a systematic review. Bjerre et al. Br J Dermatol 2017;177:1272–8.23
17. Microbiota in healthy skinand in atopic eczema. Baviera et al. Biomed Res Int 2014;2014: 436921.
18. Temporal shifts in the skin microbiome associated with disease flares and treatment in children with atopic dermatitis. Kong et al. Genome Res 2012;22:850–9.
19. Effect of a lotion containing the heat-treated probiotic strain Lactobacillus john-sonii NCC 533 on Staphylococcus aureus colonization in atopic dermatitis. Blanchet-Rethore et al. Clin Cosmet Invest Dermatol 2017;10:249–57.
20. Interleukin-8 production by polymorphonuclear leukocytes from patients with chronic infected leg ulcers treated withLactobacillus plantarum. Peral et al. Clin Microbiol Infect 2010;16: 281–6.
21. The efficacy of probi-otics as pharmacological treatment of cutaneous wounds: meta-analysis of animal studies. Tsiouris et al. Eur J Pharm Sci 2017; 104:230–9.
22. Bacteriotherapy with Lactobacillus plantarum in burns. Peral et al. Int Wound J2009;6:73–81
23. Selective antimicrobialaction is provided by phenol-soluble modulins derived from Staphylococcus epidermidis, a normal resident of the skin. Cogen et al. J Invest Dermatol2010;130:192–200.
24. Expression of a heterologous manganese superoxide dismutase gene in intestinal Lactobacilli provides protection against hydrogen peroxide toxicity. Bruno-Barcena et al. Appl Environ Microbiol. 2004;70(8):4702–4710.
25. Antioxidant and free radical scavenging activities of an exopolysaccharide from a probiotic bacterium. Kodali and Sen. Biotechnol J. 2008;3(2):245–251.
26. Small intestinal bacterial over-growth in rosacea: clinical effectiveness of its eradication. Parodi et al. Clin Gastroenterol Hepatol 2008;6:759–64.
27. Prospective, randomized, open-label trial comparing the safety, efficacy, and tolerability of an acne treatment regimen with and without a probiotic supplementand minocycline in subjects with mild to moderate acne. Jung et al. J Cutan Med Surg. 2013;17:114–22.44
28. Dietary effect of lactoferrin-enriched fermented milk on skin surface lipid and clinical improvement ofacne vulgaris. Kim et al. Nutrition 2010;26:902–9.
29. Probiotics for the treatment of atopic dermatitis in children: a systematic review and meta-analy-sis of randomized controlled trials. Huang et al. Front Cell Infect Microbiol 2017;7:392.29.
30. Synbiotics for prevention and treatment of atopic dermatitis: a meta-analysis of randomized clinical trials.Chang et al. JAMA Pediatr 2016;170:236–42.
31. Probiotics for treating eczema. Makrgeorgou et al. Cochrane Database of Systematic Reviews 2018, Issue 11. Art. No.: CD006135. https://www.cochrane.org/CD006135/SKIN_probiotics-treating-eczema