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Evidence Based

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How to Get the Best Benefit From Probiotics for Skin Health

Written by Dr. Michael Ruscio, DC on January 20, 2024

Written by Dr. Michael Ruscio, DC on January 20, 2024 — Reviewed by Dr. Hannah Hamlin

Your Skin Relies on Healthy Bacteria to Function Properly, But Are Oral or Topical Probiotics More Helpful?

• The Gut-Skin Connection|
• Probiotics for Skin|
• Heal Your Gut, Heal Your Skin|

Believe it or not, your skin and digestive tract have much in common. What do I mean by that? Just like a healthy gut, healthy skin requires a balanced and diverse ecosystem of microorganisms to function properly. Your largest organ, the skin, covers your whole body and acts as a protective barrier between you and the world, much like your intestinal lining protects your body’s interior from the foods you eat and potentially harmful pathogens therein.

Both organs provide clues or indicators of your overall health and wellness, and addressing gut issues often shows up, at least in part, as improved skin health. The conversation between your skin and your gut is well-established, called the gut-skin axis.

Understanding this connection will likely transform your approach to skincare. Whether you’re concerned about skin conditions like eczema, acne, psoriasis, or rosacea, or simply wondering if there’s a better way to take care of your skin as you age, linking gut care to skin care is the direction you should be headed.

Probiotics, specifically, are of interest when it comes to caring for the skin. Topical probiotics have emerged as a promising new approach to treating skin problems, and while this research is in its infancy, it’s a really interesting science. Let’s dive into probiotics for skin: the use of both oral and topical probiotics for skin conditions as a new approach to general skincare and dermatology.

A Breakdown of the Gut-Skin Connection

Skin diseases are often connected to the gut, in addition to having genetic, immune system, and lifestyle components. Both the skin and the gut require robust microbiota to remain healthy, and the two organs are structurally similar as well [1, 2, 3]. Well-established research documents the connection between gut health and skin health, pointing to skin problems as an indication that something might be going awry in the gut [4, 5, 6].

Skin Conditions Related to Poor Gut Health

Dysbiosis (an imbalance) in the skin microbiome and gut microbiome may show up as an overactive immune response, allergic reaction, or inflammatory skin disorder. Some of the most common skin conditions that fall into these categories are [2, 6, 7, 8, 9, 10]:

• Psoriasis: Psoriasis lesions are a result of the immune system attacking the skin due to an overactive inflammatory response. Psoriasis is linked to IBD, gut dysbiosis, and likely leak gut as well.
• Atopic dermatitis (Eczema): Probably autoimmune-related, eczema is likely linked to a combination of specific microbes, immune system interactions, and inflammatory diet.
• Acne: Acne sufferers tend to have lower levels of beneficial bacteria and higher levels of harmful microbes in their gut. They’re also more likely to have lower stomach acid and a higher risk of leaky gut syndrome and inflammation. Reducing sugar intake is one dietary change recommended for acne sufferers.
• Rosacea: Rosacea has been linked to SIBO, IBD, and H. pylori infection. Usually, a SIBO treatment protocol (which sometimes includes antibiotics or antimicrobials) will address rosacea, especially when paired with a probiotic.
• Seborrheic dermatitis and dandruff: These are fungal/yeast overgrowth conditions that arise when good bacteria are insufficient and unable to protect from infestation [11].

Although these are the main conditions I’ll cover here, they’re by no means the only skin conditions that are related to gut health. Functional treatments for conditions like these include diets specific to each and gut-supportive practices like taking a probiotic supplement, getting quality sleep, exercising regularly, and practicing stress-reduction techniques.

Generally, starting with a low-sugar paleo diet is a great first step in shifting your diet away from inflammatory foods if you suffer from any skin conditions. However, in some cases, more restrictive measures might be necessary. In the case of psoriasis and eczema, an AIP diet might be your best bet. Rosacea sufferers will likely benefit most from a low-FODMAP diet, especially if SIBO is present. Certain foods might trigger an immune response specifically in you, so identifying those is also a good idea if the more restrictive options aren’t helping.

The Gut-Brain-Skin Axis

A third organ to add to the gut-skin axis is the brain. I’ve talked a lot about the gut-brain axis on my podcast with experts like Dr. David Perlmutter and Dr. Stephen Olmstead. And I’ve connected mental health conditions like anxiety and depression to gut health by sharing extensive research on the topic. If you’ve been following along, you’ve likely already guessed that if the gut and skin are linked, and the gut and brain are linked, then the skin and brain would be linked as well.

But if you haven’t gone down the gut-brain axis rabbit hole just yet, here’s the easiest way to think about it:

Taken a step further and into the realm of today’s topic, clinical research also connects these same mental health conditions to certain skin disorders [20]. There’s even a field of medicine called psychodermatology, which specifically studies these connections [21]. The cause and effect seem to travel in all directions, although addressing gut health often spurs improvements in mental and skin health.

That being said, surely it’s not a stretch to imagine the negative impact poor skin health can have on a person’s self-esteem, mental health, and outlook on life. Skin issues can not only be visually unpleasant but also painful and itchy, impacting sleep quality and stress levels. Improving skin health might lead to better mental and gut health just as easily as the reverse.

It also stands to reason that mental health improvement might lead to better diet and lifestyle choices, which would positively affect gut health. In other words, all three are connected, talking to each other in meaningful ways.

Since functional medicine is heavily focused on gut health, and there’s abundant science to support the health benefits of a strong gut microbiome, I tend to start there. It’s safe to say that when you take measures to care for your gut, you’re doing far-reaching work that touches skin health and mental health. The feedback loop between these three organs is very real and supported by a broad swath of scientific research [20, 21, 22, 23].

So, what’s the best way to support skin health in the context of these important connections?

Probiotics for Skin

Some of the most common skin conditions listed above have been shown to improve when patients introduce oral probiotic supplements into their health regimen [2, 24, 25, 26, 27]. In fact, multiple systematic reviews and meta-analyses not only found that probiotics help with eczema, but can prevent children from developing it when given during pregnancy and infancy [28, 29, 30, 31]. This is such important information for mothers who know this skin condition exists in their family.

Research on the effects of probiotics on psoriasis and acne is more limited but shows promise, with research underway [32, 33, 34]. In my clinical experience, I’ve seen positive changes in patients dealing with every one of these skin conditions, as well as rashes related to Crohn’s disease. So while the benefits of probiotics across every skin condition may still require more clinical studies, there’s virtually no downside to adding oral probiotics to your skin care routine.

A literature review looked at the benefits of probiotics for a wide range of common skin concerns, including:

• Skin lightening (to reduce age spots)
• Skin moisturization (to increase water content and skin and reduce the appearance of fine lines)
• Skin barrier integrity (to protect skin from infection and toxicity)
• Anti-aging (to help suppress skin cell decay, extend skin cell life, and improve elasticity)
• Anti-photoaging (to protect against UV damage by reducing the breakdown of collagen and limiting inflammation and oxidative stress)
• Anti-wrinkling (to reduce collagen degradation and keep skin more elastic)

Overall, oral probiotics show the potential to address various general skin concerns and improve overall skin health.

Topical Probiotic Skin Care

Topical probiotics are a new and interesting approach in dermatology that’s rapidly rising in popularity. It seems that virtually every prominent skincare line now offers a probiotic topical. But the truth is, we’re still learning about topicals and whether or not they’re worth the money. A 2022 review of the current research found evidence to suggest that certain skin problems may benefit from topical probiotics, but we have a long way to go before we have a tried and true protocol to recommend [35]. Let’s take a look at the research we do have.

Acne

Specific bacteria have been studied for their ability to reduce acne breakouts at the topical level. They may do this by improving the skin barrier function, reducing pustules, and increasing antimicrobial peptides that can fight acne-causing bacteria [35]. The probiotic strains that have been studied so far are Streptococcus thermophilus, Enterococcus faecalis,  S. salivarius, and Lactobacillus paracasei. Randomized controlled trials comparing these strains* to a placebo found that the topical probiotics were just as effective with fewer side effects [35, 36].

Seborrheic Dermatitis and Dandruff Treatments

Some studies have shown that probiotics such as Vitreoscilla filiformis and Lactobacillus paracasei* may help reduce the excess growth of yeast that causes these conditions [35]. Using probiotic shampoos for at least four weeks, and up to four months seems to be the common approach to get rid of the yeast that causes these issues.

Interestingly, one study used heat-killed bacteria, and it was still effective. This is useful information, as it’s not very practical to keep your shampoo in the refrigerator. We know that heat-killed probiotics are just as effective as live microorganisms in the gut as well, so it’s not surprising that this approach works topically [37].

Atopic Dermatitis (Eczema)

Topical probiotics have far less evidence to support their use for eczema than oral probiotics. However, the limited research on topical probiotics has shown positive results, and they appear to be safe [35, 38].

Topical probiotics like Vitreoscilla filiformis and Streptococcus thermophilus* have effectively reduced eczema. Clinical trials have shown that Lactobacillus johnsonii and Roseomonas mucosa* formulations can inhibit the growth of Staphylococcus aureus and reduce symptoms. While this type of staph is commonly found on the skin, too much can cause skin infections and lead to other infections as well. Remember, it’s all about balance. “Bad bacteria” is often present, but it’s only bad for your health when it grows out of balance, leading to infection or dysbiosis [35].

*Note: Just because these strains have been studied and shown to be effective for topical use doesn’t mean that they’re the only ones that will be effective. Dermatologists and other medical scientists are still learning about how topical probiotics behave on the skin, but we already know a lot about how they behave in the gut. In the gut, the specific strains don’t seem to matter—rather, ensuring that there’s a variety of strains, species, and categories leads to better results. It remains to be seen if the same is true for topicals, but I’d venture a guess that it is.

DIY Topicals

You might be wondering whether it would make sense to save a few dollars on skin care by using plain yogurt as a topical. Yogurt is a fermented food with lots of live bacteria, and it’s good for your gut microbiota, so maybe it’s good for your face, too?

The answer is–maybe. Yogurt masks have gained popularity as a DIY alternative to expensive probiotic creams. While there’s no research looking specifically at the use of yogurt topically, the other topical research I’ve already cited here could support trying this out, especially for acne [35, 36].

While I won’t call it medical advice, I will say that this train of thought does make sense. Yogurt contains a wide range of probiotics, so using it as a face mask may help the way other topicals seem to. You’ll want it to be plain with no added sugar, and you may consider adding in additional ingredients from your kitchen for added benefits (honey, aloe vera, and turmeric are all suggestions in the DIY recipes you’ll find online).

I’ll caveat that if you have a dairy allergy, you’ll want to skip dairy yogurt and go for a coconut or other plant-based option instead. Just watch for added sugars.

Combine the ingredients or just use the plain yogurt, and leave the mask on your face for up to 15 minutes, then rinse. If you have sensitive skin, you might test a small area at your jawline first before applying it to your whole face, and it’s probably a good idea to run this by your dermatologist if you have any other concerns.

Again, trying this out would be an experiment, as the science isn’t there to support a DIY method like this. It’s low-risk since a container of plain yogurt only costs a couple of dollars, but if you’re looking to maximize your skincare investment, it’s still wisest to put those dollars toward science-backed oral probiotics.

Heal Your Gut, Heal Your Skin

The bottom line is that gastrointestinal health greatly impacts skin health. When your gut has a varied and wide array of microbiota, it also has a strong gut barrier and can protect your body from pathogens and toxins that could wreak havoc on your whole system. And when the same goes for your skin. Although the ecosystems aren’t identical, both your skin and your gut benefit from the good bacteria that live there.

We know that oral probiotics can help address skin concerns, ranging from painful psoriasis lesions and acne to fine lines and wrinkles, and early research looks promising for topicals for conditions like acne and dandruff.

Taking a daily probiotic is one of the first things I advise for my patients who are struggling with skin issues. If you’d like support on your health journey, reach out to our clinic. We’d love to help.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.