Could Probiotics be the Ultimate Cure for Acne?

If you look at the anecdotal reviews of probiotic supplements on a whole, you see a pretty striking rate of highly satisfied customers! People truly cherish their probiotics, and some even credit their supplementation for improving various conditions and their overall health. While most people claim an improvement in digestive symptoms only, some even go so far as to suggest these supplements improved their skin. But do these anecdotes really stand up to the test?

At this time, we just don’t have a lot of research to go on, but there are some observations we can make.

One randomized, double-blind, placebo-controlled study of 56 children aged 6-18 months with moderate or severe atopic dermatitis found that those who received L fermentum probiotic supplements had improved severity in symptoms. Another study also found that two other strains also improved atopic dermatitis symptoms in children. However, a follow-up of the second study, found that Lactobacillus rhamnosus and Bifidobacteria lactis improved atopic dermatitis, but only in food sensitized children.

A meta-analysis (a large review of studies) evaluated the use of ingested probiotics on the improvement of eczema symptoms in children, and found probiotics to be an ineffective treatment option.

While atopic dermatitis and eczema aren’t acne, these studies may help shed light on the direction we can expect acne-oral probiotic research to go.

Still, with studies showing other positive effects from using oral probiotics, it’s still unclear whether the benefits would outweigh the known (and potential) risks.

While I believe that oral probiotics have some potential as health-promoting supplements, if we can advance our knowledge a bit more, I hold much more hope for topical applications of probiotics, and for good reason.

The first report that topical use of probiotics may be helpful in acne and other skin conditions was published in 1912, but until more recently we haven’t had much hard evidence.

To start, we now know that dysbiosis in the skin’s microbiome can lead to disease. Probiotics have been shown to alter the skin’s microbiome, improving the moisture barrier and impeding P. acnes bacteria through the production of antibacterial proteins. Topical application could even result in a 50% - 89% reduction in acne papules and pustules, in both number and severity. Another study similarly found that topical probiotics work by inhibiting the skin’s colonization by “bad bacteria”, and by producing potent antimicrobials that prevent pathogen adhesion. I am all for preventative medicine in skin care!

In several other studies, a cream containing Streptococcus thermophiles caused an increase in ceramide production in the skin, which works to improve the skin’s barrier. Not only did the cream amp up the production of ceramides, which play an essential role in the skin’s water-holding abilities, but patients also directly experienced less skin itching, redness, dryness and flaking as a result.

Probiotic bacteria also produce acidic compounds like lactic acid, known to be beneficial for the skin, which then acidifies the skin and discourages the growth of certain pathogens while promoting “good bacteria”.

By decreasing the amount of P. acnes on the surface of the skin, and inducing the production of healthy ceramides, topical probiotics can restore important fats which can benefit acne directly, and counter common side effects resulting from acne therapies.

Other papers have focused on the potential for topical probiotics to be used in other wound healing and infection, with promising results.

Looking at the research in an overview, it seems pretty clear to me that topical probiotics, particularly certain strains, hold enormous potential in skin care and the treatment of skin issues like acne.

Everything I’ve ever encountered with probiotic research has emphasized the importance and diversity in species, and in strains. Most studies can only focus on a few of the thousands of species, and a few of their potential strains. Therefore, we can expect the research to be slow and painful. But just because current research doesn’t indicate a strong benefit from probiotic supplementation at this point, doesn’t mean there isn’t the potential for future research.

Some people, like myself, believe bacteria to hold far more potential than we have yet recognized, and so, hold out for promising research in the years to come.

So, are probiotics the ultimate cure for acne?

For many people, probably not – the pathophysiology of acne is often much more complex than just what’s on the skin’s surface. The literature on probiotics, though very promising, is still in its infancy. But could using probiotics still drastically help some people – people with damaged or dehydrated skin, for example? I certainly think so. In fact, in my humble opinion, I think probiotics may hold the potential to change skin and health care as we know them. With antibiotic resistance on the rise, and the body of evidence on the importance of microorganisms growing, the time is upon us to start heavily entertaining these promising alternatives. I think microbiology and germ studies still have a lot left to teach us.