Probiotics for Skin Health: Do They Actually Work?

Skin problems often start deeper than the skin itself.

Acne, eczema, psoriasis, and rosacea have all been linked to changes in the gut microbiome, making gut health an important part of any long-term skincare strategy. While topical probiotics have become increasingly popular, the strongest evidence today still supports taking probiotics orally to improve the gut-skin axis.

In this article, I’ll explain how the gut and skin communicate, what the research says about oral versus topical probiotics, and where each approach may fit if you’re trying to improve your skin.

The Gut-Skin Axis: How Your Gut Affects Skin Health

Healthy skin depends on more than a good skincare routine. Research suggests your gut microbiome has the potential to influence inflammatory skin conditions like acne, eczema, psoriasis, and rosacea 1 2 3.

Your gut is home to a diverse community of microorganisms that helps regulate inflammation and maintain a healthy immune barrier. When that community in your GI tract becomes imbalanced (called dysbiosis), it may contribute to inflammation that goes beyond your gut and often affects your skin. This is commonly known as the gut-skin axis.

Genetics, environment, and lifestyle all play a role in skin health. But because the skin is quite sensitive to changes in the gut microbiome, supporting gut health is often one of the first places I recommend starting.

The Skin As an Immune Organ

The skin isn’t just a protective covering; it’s one of the body’s largest immune organs. It’s home to specialized immune cells that constantly monitor for pathogens, allergens, and injury, helping regulate inflammation and maintain a healthy skin barrier 4.

Because these organs communicate through the immune system, which contains up to 80% of your immune cells, changes in gut health can influence inflammatory signaling elsewhere in the body. In susceptible people, this may contribute to skin inflammation and worsen common skin conditions.

This may also help explain why skin symptoms are common in many autoimmune and chronic inflammatory conditions. While these diseases have different underlying causes, many involve immune dysregulation and changes in gut health that may influence the skin.

Mast Cells: A Connection Between the Gut and Skin

Mast cells are immune cells found in high numbers in both the skin and the digestive tract. Under normal circumstances, they help protect against infection and support tissue repair. But when they’re overactivated, they release inflammatory compounds like histamine that can contribute to itching, flushing, hives, swelling, and redness.

Researchers are increasingly studying how the gut microbiome and mast cells communicate, which may help explain why some people experience both digestive and skin symptoms. This connection is also being explored in mast cell activation syndrome (MCAS). While probiotics aren’t a treatment for MCAS, supporting gut health may help reduce one source of immune activation as part of a broader treatment plan. More research is still needed on this.

Skin Conditions Linked to Gut Health

Dysbiosis 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 5:

Psoriasis lesions are a result of an overactive immune system that causes abnormal skin cell growth and inflammation. Psoriasis is linked to inflammatory bowel disease (IBD), gut dysbiosis, and likely leaky gut syndrome as well 6 7.

Atopic dermatitis (eczema) has a growing body of research on its relation to autoimmunity, with possible links to a combination of specific microbes, immune system interactions, and inflammatory diets 8.

Acne, the inflammation or infection of sebaceous glands in the skin, is related to lower levels of beneficial bacteria and higher levels of harmful microbes in the gut. People with acne may also be more likely to have lower stomach acid, a higher risk of leaky gut syndrome, and inflammation 3 9. Reducing sugar intake is one dietary change recommended for those experiencing acne 10.

Rosacea has been linked to small intestinal bacterial overgrowth (SIBO), IBD, and H. pylori infections 11 12. Usually, a SIBO treatment protocol (which sometimes includes antibiotics or antimicrobials) will address rosacea 13, especially when paired with a probiotic.

Seborrheic dermatitis and dandruff are fungal (yeast) overgrowth conditions that can arise when good bacteria are insufficient and unable to protect from the overabundance of yeast 14.

While 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 balanced diets, 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 Autoimmune Protocol (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 the next step if the diets aren’t moving the needle with your skin condition.

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

Oral Probiotics for Skin Health

Some of the most common skin conditions (listed above) have been shown to improve when people introduce oral probiotic supplements into their health regimen 5 15 16 17.

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 18 19 20 21. This is valuable information for parents who know this skin condition may be genetically passed down.

Research on the effects of probiotics on acne and psoriasis is more limited but shows promise, with research underway 9 22 23. In my clinical experience, I’ve seen positive changes in patients dealing with 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 research, there’s virtually no downside to adding oral probiotics to your skin care routine.

Beyond skin conditions, there is current research supporting the use of probiotics to support general skin health as well, namely anti-aging, moisture retention, and more 16. 

A literature review, with many results coming from topical applications and animal studies, looked at the benefits of probiotics for a wide range of common skin concerns, including 16:

• Skin lightening to reduce age spots
• Skin moisturization to increase water content in 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 Probiotics for Skin

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 24. Let’s take a look at the research we do have.

Acne

Specific beneficial 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 24. 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 than traditional acne treatment 25.

Seborrheic Dermatitis and Dandruff Treatments

Some studies have shown that probiotics such as Vitreoscilla filiformis (topical) and Lactobacillus paracasei (oral)* may help reduce the excess growth of yeast that causes these conditions 24. Using probiotic shampoos for one 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 26.

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 24 27.

Topical probiotics like Vitreoscilla filiformis and Streptococcus thermophilus* have effectively reduced eczema 24. Clinical trials have shown that Lactobacillus johnsonii and Roseomonas mucosa* formulations can inhibit the growth of Staphylococcus aureus and reduce symptoms 24. 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” are often present, but they are only bad for your health when they grow out of balance, leading to infection or dysbiosis 24.

*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 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. The research is still developing on whether the same is true for topicals, but I’d venture a guess that it is.

I’m not advising against trying topicals for yourself, but skin care products can get expensive. 

If you have to choose between a topical and an oral, the science supports going with oral probiotics for now. Specifically, in the cases of psoriasis and rosacea, there’s not enough evidence to support topical use yet. And although research is underway, much more work is needed to support topical probiotics for eczema. The most promising research looks at topicals for acne and dandruff 24.

Bottom Line on Probiotics for Skin Health

The bottom line is that gastrointestinal health greatly impacts skin health. When your gut has a varied and wide array of microbiota, it will also have a strong gut barrier that can protect your body from pathogens and toxins that could wreak havoc on your whole system. 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. We’ve developed our probiotic formulations specifically to support a diverse, resilient gut microbiome, which is the foundation this whole gut-skin connection is built on. If you’re ready to start, our Triple Therapy Probiotics are a good place to begin.

If you’d like more personalized support on your health journey, reach out to our clinic. We’d love to help. Book a consultation with one of our clinicians.

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