Acne, Microbiome, and Probiotics: The Gut–Skin Axis

Abstract

The objective of this narrative review was to check the influence of the human microbiota in the pathogenesis of acne and how the treatment with probiotics as adjuvant or alternative therapy affects the evolution of acne vulgaris. Acne is a chronic inflammatory skin disease involving the pilosebaceous units. The pathogenesis of acne is complex and multifactorial involving genetic, metabolic, and hormonal factors in which both skin and gut microbiota are implicated. Numerous studies have shown the bidirectionality between the intestinal microbiota and skin homeostasis, a communication mainly established by modifying the immune system. Increased data on the mechanisms of action regarding the relevance of Cutibacterium acnes, as well as the importance of the gut–skin axis, are becoming known. Diverse and varied in vitro studies have shown the potential beneficial effects of probiotics in this context. Clinical trials with both topical and oral probiotics are scarce, although they have shown positive results, especially with oral probiotics through the modulation of the intestinal microbiota, generating an anti-inflammatory response and restoring intestinal integrity, or through metabolic pathways involving insulin-like growth factor I (IGF-1). Given the aggressiveness of some standard acne treatments, probiotics should continue to be investigated as an alternative or adjuvant therapy.

Latilactobacillus sakei Wikim0066 Protects Skin through MMP Regulation on UVB-Irradiated In Vitro and In Vivo Model

“…Recent studies have reported that gut flora affects the skin [ 22 ]. The gut microbiome affects the skin by regulating the function and composition of the innate or adaptive immune system [ 30 ]. In addition, metabolites such as SCFAs including acetic, butyric, and propionic acid produced by gut microbes can be released into the bloodstream and act on distant organs and systems such as the skin [ 16 ].…”

How Our Microbiome Influences the Pathogenesis of Alopecia Areata

“…Data from this study may suggest that its increased presence could be associated with greater severity. C. acnes is a bacterium of crucial importance in skin diseases such as acne vulgaris [ 27 ] and even in patients with androgenic alopecia as it has been observed to increase in the scalp microbiota [ 126 ].…”

“…Several probiotics have shown beneficial effects as adjuvant treatments in some inflammatory skin diseases such as atopic dermatitis, psoriasis, acne, etc. [ 26 , 27 ]. Given the exposed nature of the pathogenesis of alopecia areata and given the immunomodulatory or anti-inflammatory properties of some probiotics [ 167 ], it would be convenient in the future to explore this research.…”

“…The pathogenesis of alopecia areata has not been fully elucidated [ 21 ], although there is evidence that it is an autoimmune disorder [ 22 ] that is also influenced by genetic predisposition [ 1 ] and other factors [ 23 ]. Due to the relationship of the skin and gut microbiota with other systemic autoimmune diseases [ 24 ] and other immune-mediated skin diseases [ 25 , 26 , 27 ], several studies on the microbiota of alopecia areata patients have been carried out in recent years [ 28 ].…”

Stabilization of Acne Vulgaris-Associated Microbial Dysbiosis with 2% Supramolecular Salicylic Acid

“…Some recent studies stated the promising anti-acne therapeutic efficacy of oral probiotics, oxybrasion, and synergistic treatment protocol of hydrogen purification and cosmetic acids [ 10 , 11 , 12 ]. However, these studies are preliminary and further validations are required to prove their safety and efficacy.…”