Acne is a common skin condition affecting millions worldwide and can cause physical and emotional distress. While traditional treatments like topical creams and medications have long been the go-to option, there is a growing interest in alternative approaches that address the root causes of acne. Probiotics, known for their positive effects on gut health, have emerged as a surprising link in the quest for clearer skin.
Acne is a multifactorial skin disorder characterized by pimples, blackheads, and whiteheads. It occurs when hair follicles become clogged with dead skin cells, excess oil (sebum), and bacteria. Hormonal fluctuations, genetics, and environmental factors contribute to acne development. Bacteria, particularly Propionibacterium acnes, are significant in triggering inflammation and worsening acne symptoms.
Understanding the Skin Microbiome
Our skin is the largest organ in our body and is a complex ecosystem teeming with microorganisms, including bacteria, fungi, and viruses, collectively known as the skin microbiome. These microorganisms live in harmony with our bodies under normal conditions and play a vital role in maintaining skin health.
However, when the skin microbiome's delicate balance is disrupted, problems arise. One such prevalent issue is acne, a condition most often associated with the bacterial species Propionibacterium acnes (P. acnes). For years, this species was seen as the primary perpetrator of acne. Still, recent scientific insights suggest that it's not solely about P. acnes but the overall balance of the skin's microbial community.
One study, led by Dr. Huiying Li at the David Geffen School of Medicine at UCLA, examined skin follicle samples from 72 people—38 with acne and 34 without. The study concluded that those with acne had more virulence-associated genes linked to the transportation of bacterial toxins harmful to the skin. The group without acne, on the other hand, had genes related to bacterial metabolism—genes thought to prevent harmful bacteria from colonizing the skin.
This research suggests that the composition of the skin's microbial community plays a significant role in skin health. More importantly, it hints that finding the key to healthier skin and a potentially effective acne treatment could be restoring a balanced microbiome.
Four key components that can support a healthy microbial environment:
- Prebiotics: These are types of indigestible carbohydrates that serve as food for beneficial microbes. Examples include Saccharomyces/Rice Ferment Filtrate, Alpha-Glucan Oligosaccharide, and Inulin.
- Probiotics: Live bacteria or fungi that, when administered in the correct dosage, provide health benefits to the host. Some examples are Lactobacillus Ferment, Bifida Ferment Lysate, and Streptococcus Thermophilus Ferment.
- Postbiotics: These are metabolites of bacteria or fungi that can have beneficial effects. They include substances like Vitamin B12, short-chain fatty acids, lactic acid, and amino acids.
- Bacteriophages: These are bacterial viruses that target and kill specific bacteria by lysing them through the injection of DNA/RNA. They are recognized as a good alternative to antibiotics, with examples like Cutibacterium Acnes Bacteriophages and S. aureus bacteriophages.
What are Probiotics?
Probiotics are live microorganisms that provide health benefits when consumed in adequate amounts. They are commonly found in certain foods and supplements. Probiotics are believed to improve the balance of gut bacteria, promote digestive health, and support the immune system. Lactic acid bacteria, such as Lactobacillus and Bifidobacterium species, are among the most widely studied probiotics.
The Gut-Skin Connection
Emerging research suggests a strong connection between the gut and the skin, known as the gut-skin axis. Imbalances in gut bacteria can lead to systemic inflammation and trigger skin issues, including acne. When the gut microbiome is disrupted, it can affect the skin's barrier function, promote inflammation, and contribute to the development of acne lesions.
What Does Gut Bacteria Have to Do with Acne?
The human gut is home to a complex ecosystem of bacteria known as the gut microbiota. Recent studies have found that individuals with acne have a different gut microbiota composition than those without acne. Specifically, there is a notable underrepresentation of beneficial bacteria such as Bifidobacterium, Butyricicoccus, Coprobacillus, Lactobacillus, and Allobaculum in the gut of acne patients. In addition, the distribution of Proteobacteria, a major bacterial group found in the human gut, is significantly higher in individuals with acne. This species includes pathogenic bacteria like E. coli, Salmonella, and Vibrio cholerae, potentially contributing to the condition.
Can Oral Probiotics Help Reduce Acne?
A few studies that explored the relationship between gut bacteria and acne suggest that imbalances in gut microbiota may play a role in the worsening of acne. They also highlight the potential benefits of probiotics in restoring this balance and aiding in acne treatment.
Possible mechanisms by which probiotics can help people with acne:
- Strengthening the Immune Response: Bifidobacterium and Lactobacillus, two types of beneficial bacteria, were found to generate regulatory dendritic cells and regulatory T cells. An abundance of these cells leads to the suppression of cytokine production, which is often linked to inflammation and acne.
- Improving the Intestinal Barrier Function: These beneficial bacteria also directly affect the intestinal epithelial barrier function, enhancing its resistance and decreasing permeability. This is crucial for overall gut health.
- Foods rich in dairy and carbohydrates increase the risk of acne, probably by elevating Insulin Growth Factor-1 (IGF-1). Adding Lactobacillus to fermented milk caused a 4-fold decrease in IGF-1 compared with nonfermented skim milk. Thus, probiotics could improve acne by regulating the IGF-1 level.
In the 1960s, Dr. Robert H. Siver pioneered the first clinical study to assess the effects of probiotics on acne. He used an oral probiotic blend of L. acidophilus and L. bulgaricus on 300 patients. The treatment regimen included an 8-day course of probiotics followed by a two-week break, then resumed. Siver found that 80% of the participants experienced some form of improvement, especially in inflammatory lesions.
Later studies have continued exploring oral probiotics' role in acne treatment. An Italian research project involving 40 participants used an oral supplement containing 250 mg of freeze-dried L. acidophilus and Bifidobacterium bifidum as an adjunct to standard therapy. The results indicated better clinical outcomes and increased tolerance for oral antibiotics in the probiotic group. Another study also reported quicker clinical improvement in acne patients who were given supplements to correct intestinal microflora alongside traditional acne treatments.
A more recent clinical trial showed that combining oral antibiotics with probiotics could offer additive benefits, particularly for inflammatory acne. In this study by Jung et al., 45 female participants were divided into three groups: those receiving only probiotics, those on minocycline alone, and a third group taking both. All groups showed a substantial reduction in acne lesions over 12 weeks. However, those taking both probiotics and minocycline experienced the most significant improvements. Additionally, two individuals from the minocycline-only group developed vaginal yeast infections.
In another study done in Italy, 20 adults with acne took a supplement containing a specific probiotic, Lactobacillus rhamnosus GG, or a placebo for 12 weeks. Those who took the probiotic saw a noticeable improvement in their acne. The study also found changes in certain markers in the skin that indicate reduced inflammation and better skin health. While this study was small, it suggests that probiotics might be helpful for people with acne, but more research is needed to confirm these findings.
Potential Side Effects
While probiotics are generally safe for most people, it's essential to exercise caution, especially if you have a compromised immune system or are taking immunosuppressive medications. In rare cases, probiotics may cause mild gastrointestinal symptoms such as bloating or diarrhea. If you experience any adverse effects, discontinue use and consult a healthcare professional.
You can consume probiotics orally through supplements or foods rich in probiotics or apply them topically using probiotic-infused skincare products. Following the manufacturer's instructions when using supplements and topical products is crucial. Regularly incorporating probiotic-rich foods into your diet can be beneficial as well.
How to Combine Probiotics with Traditional Acne Treatments?
Probiotics offer a more balanced approach to managing acne, but they shouldn't be viewed as a substitute for conventional treatments, particularly for more severe cases. Instead, they can serve as a supplementary component in a well-rounded acne treatment regimen that also includes topical applications, oral medications, and lifestyle adjustments.
There's an ongoing debate about the most effective probiotic strains for acne treatment. Generally, it's advised to opt for probiotic supplements that contain at least the following live cultures:
- Lactobacillus acidophilus
- Lactobacillus paracasei
- Lactobacillus plantarum
- Enterococcus faecalis
- Streptococcus salivarius
If you're committed to enhancing your gut health as a pathway to better skin, consider investing in a reputable, high-quality probiotic supplement.
- Garden of Life Dr. Formulated Once Daily Women's Shelf Stable Probiotics 16 Strains, 50 Billion CFU - $26.54
- Renew Life Women's Probiotic - Ultimate Flora Probiotic Women's Care - $15.99
In addition to probiotic supplements, you can increase your consumption of foods with naturally occurring probiotics, such as yogurt (non-sweetened!), sauerkraut, kombucha, etc. The American Academy of Family Physicians suggests a dosage of 10 to 20 billion colony-forming units per day. Probiotic yogurts contain 5 to 10 billion colony-forming units per 4-ounce portion, so they may not be enough to help combat skin inflammation independently.
Can Everyone Use Probiotics for Acne?
Generally, most people can safely use probiotics. However, individuals with weakened immune systems or those on immunosuppressive medication should consult their doctor before starting probiotics. Some people might experience minor side effects such as bloating or diarrhea.
While probiotics are not a silver bullet for acne, their potential in managing acne symptoms is increasingly recognized. As a component of a comprehensive skincare routine and a healthy lifestyle, probiotics can contribute to improved skin health. Ongoing research is exciting, and we might soon learn more about how probiotics interact with our skin and how they can be best utilized for skin health.
Q1: Can probiotics completely cure acne?
While probiotics show promise in managing acne symptoms, they are unlikely to provide a complete cure. Acne is a complex condition influenced by various factors, and a holistic approach that includes lifestyle changes, proper skin care, and a healthy diet is typically necessary for long-term improvement.
Q2: How long does it take to see results when using probiotics for acne?
The timeline for seeing results with probiotics can vary from person to person. Some individuals may notice improvements within a few weeks, while others may require several months of consistent use. Patience and regularity are key when incorporating probiotics into your skincare routine.
Q3: Are there any specific foods that can naturally increase probiotics in the body?
Yes, certain foods can naturally increase probiotics in the body. Fermented foods like yogurt, kefir, sauerkraut, and kimchi contain live bacteria and can help replenish beneficial gut bacteria. Including these foods in your diet can complement probiotic supplements or topical products.
Q4: Can probiotics worsen acne symptoms in some individuals?
In rare cases, probiotics may cause mild aggravation of acne symptoms. It's essential to monitor your skin's response when introducing probiotics and discontinue use if you notice any adverse effects. Consulting with a dermatologist or healthcare professional can provide personalized guidance.
Q5: Can probiotics help with acne scars?
While probiotics primarily focus on managing acne symptoms, they may indirectly contribute to improving acne scars. By promoting a healthy skin microbiome and reducing inflammation, probiotics can support the skin's healing process and enhance overall skin health, potentially reducing the appearance of acne scars.
- "Acne vulgaris, probiotics, and the gut-brain-skin axis: from anecdote to translational medicine." Benef Microbes. 2011;2(1):13-23.
- "Supplementation with Lactobacillus rhamnosus SP1 normalizes skin expression of genes implicated in insulin signaling and improves adult acne." Benef Microbes. 2016;7(5):625-630.
- "The gut microbiome as a major regulator of the gut-skin axis." Front Microbiol. 2018;9:1459.
- "Antimicrobial activity of enterocins from Enterococcus faecalis SL-5 against Propionibacterium acnes, the causative agent in acne vulgaris, and its therapeutic effect." J Microbiol. 2013;51(1):130-137.
- "The human skin microbiome." Nat Rev Microbiol. 2018;16(3):143.
- "Epigallocatechin-3-gallate improves acne in humans by modulating intracellular molecular targets and inhibiting P. acnes." J Invest Dermatol. 2014;134(2):429-440.
- "Cutibacterium acnes (Propionibacterium acnes) and acne vulgaris: a brief look at the latest updates." J Eur Acad Dermatol Venereol. 2018;32(S2):5-14.
- "Skin health and gut microbiota: a new perspective." Food Sci Biotechnol. 2021;30(1):1-10.
- Yan HM, Zhao HJ, Guo DY, Zhu PQ, Zhang CL, Jiang W. Gut microbiota alterations in moderate to severe acne vulgaris patients. J Dermatol. 2018;45(10):1166-1171.
- Marchetti F., Capizzi R., Tulli A. Efficacy of regulators of the intestinal bacterial flora in treating acne vulgaris. Clin. Ter. 1987;122:339–343.
- Fabbrocini G, Bertona M, Picazo Ó, Pareja-Galeano H, Monfrecola G, Emanuele E. Supplementation with Lactobacillus rhamnosus SP1 normalizes skin expression of genes implicated in insulin signaling and improves adult acne. Benef Microbes. 2016;7(5):625–630.
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