Targeting the gut‐skin axis—Probiotics as new tools for skin disorder management?

Abstract

The existence of a gut-skin axis is supported by increasing evidence, but its translational potential is not widely recognized. Studies linked inflammatory skin diseases to an imbalanced gut microbiome; hence, the modulation of the gut microbiota to improve skin condition seems to be a feasible approach. Today, there is a growing interest in natural products as alternatives to synthetic drugs. In this respect, oral probiotics could be a simple, safe and cheap modality in the therapeutic management of skin inflammation. Unfortunately, very few studies have looked into how probiotic supplementation influences inflammatory skin disorders. The result, though promising, are difficult to implement in clinical practice due to the heterogeneity of the applied supplemental regimen in the different studies. In this Viewpoint, we aim to encourage the conduction of more research in that direction to explore unambiguously the therapeutic potential of oral probiotics in dermatology. We focus on the most common inflammatory skin diseases (atopic dermatitis, psoriasis, rosacea, acne vulgaris) with an associated gut dysbiosis, but we also discuss some less common, but very serious skin pathologies (eg erythema nodosum, pyoderma gangrenosum, hidradenitis suppurativa) that are possibly linked to a disturbed gut flora composition. We dissect the possible mechanisms along the gut-skin axis and highlight novel points where probiotics could interfere in this communication in the diseased state.

Gut Microbiome in Psoriasis: An Updated Review

“…In mice with an experimental model of psoriasis induced by imiquimod, oral treatment with broad-spectrum antibiotic reduces the severity of skin inflammation through downregulation of Th17 immune response [12,13]. These results are supported by clinical observations based on a case series showing improvement in psoriatic skin lesions after antibiotic treatment [14], modulation of gut microbiota by probiotics [15] or fecal microbial transplantation [16].…”

Rosacea and the Microbiome: A Systematic Review

“…A compromise in the mucosa, either through changes in the microbiome or autoimmune disease, may result in pernicious substances entering the bloodstream and affecting peripheral sites [13]. Previous studies have linked inflammatory skin diseases with an imbalanced gut microbiome [2,23,24]. Resident gut bacteria may serve as the underlying trigger to an exaggerated immune response, and the improvements in both IBD and rosacea symptoms with oral metronidazole therapy support this notion [25].…”

The Role of the Cutaneous Microbiome in Hidradenitis Suppurativa—Light at the End of the Microbiological Tunnel

“…This intriguing possibility underpinned by research demonstrating the altered gastrointestinal microbiome in patients with inflammatory dermatoses [70]. Indeed, there is a growing interest in the gut-skin-axis, with probiotics already being postulated as a future treatment strategy for skin disorders including HS [71].…”

“…The cross-talk between the cutaneous and gut microbiome, termed the gut-skin axis, is currently the focus of intense research [87]. Indeed, there is evidence that exposure of the skin to ultraviolet radiation can alter the gut microbiome [88] and modulation of the gut microbiome may represent a novel mechanism to treat skin diseases [71], although prospective randomized clinical trials are lacking.…”