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Evidence Based

This article is based on scientific evidence, written by experts and fact checked by experts.

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Do Probiotics Help With Acne?

Written by Dr. Michael Ruscio, DC on March 14, 2020

Written by Dr. Michael Ruscio, DC on March 14, 2020 — Reviewed by Noora Alakulppi

• What Are Probiotics|
• Benefits of Probiotics for Acne and Healthy Skin|
• Oral Probiotics Benefits|
• Topical Probiotics Benefits|
• The Best Probiotics for Acne Treatment|
• Best Oral Probiotics|
• Best Topical Probiotics|
• Can Prebiotics Treat Acne|
• Clear Skin is More Than Skin Deep|

The Gut-Skin Connection

Acne and other blemishes on the skin are distressing, no matter what your age. As someone who suffered from acne, I can attest to the frustration I felt from the lackluster results that common treatments offer.

Dermatologist-prescribed treatments range from topical ointments that can irritate your skin to long-term antibiotics. Some target bacteria, others affect hormones, and still others reduce oils in your skin.

As the old naturopathic medicine saying goes, “The skin is a reflection of the gut.”

Science supports the existence of a “gut-skin axis,” a powerful link between the gut and skin. ^{[2, 3]} Because of this link, probiotics are one therapy that shows a lot of promise for treating acne.

What Are Probiotics?

Probiotics are bacteria that are beneficial to us. You may have heard about the health benefits of eating fermented foods with so-called live cultures, like yogurt, sauerkraut, or kombucha.

Another option is to take a probiotic supplement in powder or capsule form, which usually contains a higher concentration of these good bacteria. 

Benefits of Probiotics for Acne and Healthy Skin

Probiotics help balance your gut microbiome (an ecosystem of gut bacteria and other microbial life that lives in your digestive tract) and contribute to good digestion and a healthy immune system.

Because we’re also going to look at the effects of topical probiotics, moving forward I will refer to probiotics which are taken internally—targeting your gut microbiome—as oral probiotics. Besides helping your digestion, oral probiotics can also heal key issues linked to skin health and acne reduction.

Your skin also has its own ecosystem of “flora”, or microbiome, with different strains than your gut. Researchers are also currently testing probiotics that contain healthy bacteria to be applied directly to your skin. These are known as topical probiotics.

Oral Probiotics Benefits

Researchers have been hard at work studying the effects of oral probiotics specifically for skin, such as rosacea (which can be confused with acne), atopic dermatitis, and psoriasis.

Acne-specific research that looks at the impact of oral probiotics is rarer when compared to studies on other skin conditions. Many of the conclusions we can draw about acne benefits need to be made by inference.

Despite this, there’s still a lot we can say about probiotics’ contribution to acne and healthy skin:

• People with acne may have more inflammation in their bodies.^[4] Oral probiotics can calm inflammation systemically, according to one review.^[5]
• Gut dysbiosis (or imbalance in your gut) has been linked to acne and other skin conditions. ^{[6, 7]} Oral probiotics like Lactobacillus acidophilus/ Bifidobacterium bifidum can resolve dysbiosis, according to a systematic review.^[8]
• In three clinical trials, when oral probiotics were added to other treatments like antibiotics, they were more effective at reducing acne than the other treatments alone. ^{[9, 10, 11]} 
• Hormone levels contribute to acne,^[12] and oral probiotics can improve hormonal balance, per a study of women with polycystic ovarian syndrome or PCOS.^[13]
• Rosacea, another chronic skin condition, was shown to decrease with eradication of H. pylori.^[14] Oral probiotics can help manage H. pylori.^[15]

Oral probiotics also offer a safe, natural alternative to antibiotic treatment. Frequent side effects^[16] and the growing risks of antibiotic overuse causing bacterial resistance^[17] are driving dermatology researchers to look for other options.

Topical Probiotics Benefits

In the last few years, researchers have begun to look at the impact of applying topical probiotics to skin. Here are a few general benefits that have been observed:

• Topical probiotics can be effective at reducing acne count and severity.^{[18, 19]}
• Topical probiotics can increase moisture and skin barrier function in healthy skin.^[20]
• Topical probiotics often have antibacterial properties and can decrease the side effects of other treatments.^[21]

It may seem strange to add more bacteria to your skin, when too much Cutibacterium (formerly Propionibacterium) acnes or C. acnes, a bacteria found on the skin, is commonly blamed as a contributor to acne.^[22]

However, the case is more complex than a single strain of “bad bacteria”. For one thing, C. acnes, one of the most common bacteria on your skin, seems to behave helpfully in balance.^[23]

Removing too much of it may actually be harmful. One study showed that reducing C. acnes with antibiotics could lead to overgrowth of another bacteria called Pseudomonas, associated with skin infections.^[24]

Newer genetic testing has also revealed that there are multiple sub-strains of C. acnes, only a few of which may be pathogenic.^{[25, 26]} So it shouldn’t indiscriminately be removed.

In short, your skin and gut microbiomes are microbial systems that work or fail to work in balance. The evidence suggests that a treatment like probiotics, which works to cultivate your healthy ecosystems, is more effective (with fewer side effects) than an option that targets one bacterial strain.

The Best Probiotics for Acne Treatment

Should you take oral or topical probiotics to treat your breakouts?

Topical probiotics are still very new, and human trials are limited. Some of the species clinically tested on skin are also not yet available commercially. But that situation may change as interest grows.

Oral probiotics are much more widely researched than topicals, particularly those in the Lactobacillus-Bifidobacterium category. (See my guide to the three main categories of probiotics.)

You’re more likely to be able to obtain a clinically-proven blend of oral probiotics. This is important. Probiotics shown to be effective in humans are more likely to calm inflammation, resolve dysbiosis, balance your hormones, and contribute to skin health.

Here are some of the best probiotics for acne, based on clinical research:

Best Oral Probiotics

The good news about oral probiotics is that you’ll get benefits to your gut-skin axis, like reduction in gut dysbiosis and inflammation, with the most clinically well-tested strains. When it comes to a specific blend for acne, a Lacto-Bifido blend (the most well-studied of all probiotics) is a safe bet.

Acne patients were found to have a decrease in Lactobacillus and Bifidobacterium bacteria.^[27] Stress is associated with acne and also impairs Lactobacillus and Bifidobacterium. Are these points related? This review of multiple trials suggests that it is.^[28]

We can infer that these beneficial and well-studied probiotic strains contribute to the gut and skin health of the healthy people used as controls in these trials. Adding these species back to your gut may also mitigate some of the harmful effects of stress on your skin.

Best Topical Probiotics

Acne has been associated with overgrowth of pathogenic bacteria (or skin dysbiosis).^{[29, 30]} Just like oral probiotics can regulate the gut microbiome, topical ones may bring the skin microbiome into balance. Here are strains that have been clinically tested and shown benefit:

• Streptococcus thermophilus was shown to increase moisture levels in healthy skin.^[31]
• A trial of Enterococcus faecalis in humans showed a 50% reduction in acne.^[32]
• Lactobacillus plantarum at 5% was shown to treat mild acne lesions.^[33]
• Bifidobacterium longum was helpful for reactive skin in one human trial.^[34]
• A few weaker studies are also of note. In a cell culture, Streptococcus salivarius reduced the growth of C. acnes. In another, Lactobacillus paracasei reduced inflammation in human tissue samples. And in a human trial, when added to another topical treatment, Lactobacillus acidophilus and Bifidobacterium bifidum helped acne more than the other treatment alone.^[35]

A few topical probiotic options are

• LiviaOne Topical Liquid Probiotics: Contains multiple strains that have shown skin benefit, including B. longum, L. plantarum, S. thermophilus, L. acidophilus, and B. bifidum.
• AllVia Topical Probiotic Cream: Contains 5% L. plantarum, which cleared mild acne clinically.^[36]
• Korres Hydra-Biome: This topical probiotic contains yogurt. The strain S. thermophilus, shown to increase moisture levels,^[37] is a standard starter culture in yogurt.

These options contain topical probiotics that have shown early promise for skin. But take their marketing claims with a grain of salt. It’s still very early for these products. Most of these topical strains were only tested with a single trial. More studies are needed to confirm these findings.

Can Prebiotics Treat Acne?

Not as much research has been done on the effect of prebiotics (fiber that helps good bacteria grow) on acne. Prebiotics are worth keeping an eye on for acne treatment. But given how few trials there are, you shouldn’t place too much weight on the results at this early stage:

• The prebiotic galactooligosaccharide (in combination with a daily oral probiotic) improved skin hydration in healthy women.^[38]
• In another human trial, researchers found that the prebiotic konjac glucomannan reduced acne and helped the skin “glow.” ^[39]
• And a gluco-oligosaccharide, a type of prebiotic, was noted to improve moisture level, barrier and the symptoms of sensitive skin.^[40]

Clear Skin is More Than Skin Deep

The skin is a reflection of the gut, and acne may be a sign of deeper imbalances in the gut, like inflammation and dysbiosis. Thankfully, oral probiotics can remedy this situation, improving both your gut and skin health. They’re a safe, natural option to add to your acne treatment. When you calm your gut, you just might calm the proverbial fire on your skin too.

It could also be worthwhile to experiment with prebiotics and topical probiotics, but test them as you would any new substance, and see how you react.

As more formulas are clinically studied and come to market, these could become a valuable addition to your regimen. Want to learn more about the healing power of probiotics? See my guide.