Elsevier

Nutrition

Volume 32, Issue 3, March 2016, Pages 289-295
Nutrition

Review
Probiotics in dermatologic practice

https://doi.org/10.1016/j.nut.2015.09.001Get rights and content

Highlights

  • •

    We studied literature concerning the use of probiotics and prebiotics of different strains and their effects on dermatologic pathologies.

  • •

    We found enough evidence regarding the protective effects of probiotics to prevent atopic dermatitis, although the effect on treating atopic dermatitis was not as clear.

  • •

    The use of probiotics on other dermatologic pathologies such as eczema, acne, and cutaneous candidiasis needs to be studied because evidence is lacking and conflicting.

Abstract

Objective

Probiotics are live microorganisms that beneficially affect the host when administered in adequate amounts. They have an excellent safety profile. Probiotics have been used as immunomodulators in inflammatory skin conditions, such as atopic dermatitis. The aim of this study was to summarize the available evidence concerning the use of different strains of probiotics in dermatology practice.

Methods

We conducted a literature review of English and Spanish publications listed in standard databases (PubMed, Ovid, Google Scholar, Medline, and EBSCO), between 1994 and 2015 using the words “probiotics” and “dermatology.” We found ∼70 studies containing these criteria and selected 42 in which probiotics were used for dermatologic purposes.

Results

We found enough evidence to recommend the use of probiotics in specific conditions in dermatology practice, especially in children with atopic dermatitis.

Conclusions

Further well-designed, large population based trials are needed to validate the use of probiotics in dermatology practice, including innovative therapies to rebuild skin barrier defects, protection against microbial colonization, and restoration of immunologic balance.

Introduction

Probiotics are live microorganisms with beneficial effects on the host when administered in adequate amounts. They have an excellent safety profile [1]. Probiotics have been widely studied because of their effects on the gastrointestinal (GI) tract and digestive functions, but these live microbes have wider applicability as evidenced by the gut–brain–skin axis theory postulated 80 y ago [2]. Details regarding use of probiotics for dermatologic indications such as atopic dermatitis (AD), acne, and sexually transmitted infections are dispersed throughout medical literature. Overall, probiotics seem to be a promising and safe therapeutic modality, but evidence up to now is limited [3].

Prebiotics have been defined as “non-digestible food ingredients that beneficially affect the host by selectively stimulating the growth and/or the activity of one or a more bacterial species already resident in the colon, and thus attempt to improve host health.” A synbiotic is defined as “a product that contains both prebiotic(s) and probiotic(s)” [4].

The most widely used bacteria as probiotics are the Lactobacilli and Bifidobacteria, but products incorporating other organisms as gram-positive cocci, bacilli, yeasts, and Escherichia coli have been applied [5]. Probiotic preparations are widely available to consumers as powders, tablets, drinks, and fermented dairy products.

Probiotics and prebiotics offer a novel concept to modulate digestive functions. Probiotics have been shown to improve calcium bioavailability, reduce risk for development of colon cancer, ameliorate mucosal inflammation in numerous GI disorders; other beneficial effects include hypoinsulinemia and control of triacylglycerol levels [6], [7], [8]. These effects occur by selectively stimulating the growth of beneficial bacteria in the colon. Probiotics can be used as a preventive measure for many diseases; however, their mechanism of action remains unclear [9], [10]. The rapid increase in the medical use of probiotics and prebiotics in recent years has confirmed their excellent safety profile. As immunomodulators, they have been used in inflammatory skin conditions, such as AD [11].

Section snippets

Potential application of probiotics in prevention of atopic dermatitis in the pre- and postnatal periods

AD is a chronically relapsing skin disease that occurs most commonly during early infancy and childhood. It is frequently associated with abnormalities in skin barrier function, allergen sensitization, and recurrent skin infections [12]. There are many applications on the role of nutrition in AD. Some examples are dietary restriction and supplementation, interventions with vitamin and mineral supplementation, as well as probiotics and essential fatty acids, from the prenatal period through

Use of probiotics with SCORAD scores in children with AD

One study demonstrated that LGG (1 × 109 colony forming units [CFU]) supplementation reduced both the risk for and severity of AD. Three randomized controlled trials, two from the Finnish group and one from Denmark, conducted in infants with preexisting AD, showed a statistically significant reduction in the Scoring Atopic Dermatitis (SCORAD) score. SCORAD is a clinical tool used to assess the extent and severity of eczema. The criteria used are based on the following:

  • 1.

    Extent criteria, which

Use of probiotics with SCORAD scores in adults with AD

The effects of probiotics were studied using SCORAD scores and the Dermatology Life Quality Index (DLQI), a 10-question validated questionnaire that has been used in >40 different skin conditions to evaluate the effect of the disease and treatment in patient's lives [25]. In terms of improvement, the study showed cytokine production by peripheral blood mononuclear cells (PBMCs) and the ability to modify fecal microbial flora. No significant adverse events were recorded during the study.

Potential application of probiotics in treatment of AD in adults

Misery studied the new therapeutic perspectives for AD and found that topical anti-inflammatory substances, selective glucocorticoid receptor agonists, probiotics, IFN-γ, tumor necrosis factor (TNF)α inhibitors, inhibition of T or B cells, and inhibition of IgE binding may reduce the severity and help prevent this condition [28].

Cytokine stimulation and fecal microbiota was evaluated by detecting three strains of L. salivarius. Results showed clinical improvements in adults with AD.

Randomized trials in prevention and treatment of AD

There are several small, randomized controlled trials that have suggested that the use of probiotics can reduce AD severity and may be able to prevent AD to some degree (Table 1) [24], [30], [31], [32], [33], [34], [35].

The studies listed in Table 1 [24], [30], [31], [32], [33], [34], [35], performed in children or infants at risk for developing AD or in children with food allergies, demonstrated that specific strains of probiotics help to control AD, by modulating immune response and

Probiotic effect on immune responses

Probiotics help maintain gut immune homeostasis by directly modulating immune responses, enhancing epithelial barrier function, and inhibiting pathogen growth. Probiotics interact with the mucosal immune system via the same pathways as commensal bacteria, specifically via interaction with epithelial cells to influence both innate and adaptive immune responses. Probiotic effects on immune responses appear to be immune regulating rather than immune activating [36]. In vitro and in vivo studies in

Delivery of probiotic bacteria

Beneficial effects of probiotic bacteria are dependent on ingestion of the live form. Bacteria must survive the host's digestive process, colonize the intestine, as well as attach and adhere to gut epithelium to mediate their effects in vivo. Moreover, heat-inactivated probiotic bacteria have been reported to cause adverse GI symptoms and diarrhea requiring discontinuation of therapy [54]. Probiotics produce bacteriocins, hydrogen peroxide, and biosurfactants to aid their survival in the

The specificity of probiotic effects

It is clear that different probiotic species and strains can have very different effects both in vivo and in vitro. The clinical or laboratory effects of one probiotic cannot be assumed for another probiotic species, or even for different strains of the same species. For example, in a double-blind placebo-controlled trial comparing LGG and a mixture of four probiotic strains (LGG, L. ramnosus LC705, B. breve Bbi99, and Propionibacterium JS) for the treatment of infant eczema, beneficial effects

Acne

It has been noted that there is a GI mechanism for the overlap between depression, anxiety, and skin conditions such as acne [36]. It has been hypothesized that emotional states might alter the normal intestinal micro flora, increase intestinal permeability, and contribute to systemic inflammation [64]. Many aspects of this gut–brain–skin unifying theory have been validated. The ability of the gut microbiota and oral probiotics to influence systemic inflammation, oxidative stress, glycemic

Conclusions

Probiotics seem to be a promising and safe therapeutic modality. There is enough information about the protective effect of probiotics to prevent AD, although the effect on treating AD is not as clear. The use of probiotics for other dermatologic pathologies such as eczema, acne, and cutaneous candidiasis needs further study because the evidence is limited and conflicting. Further well-designed, larger population-based trials are needed before we can validate the use of probiotics in

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