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Probiotics are live microorganisms that impart health benefits to the host when present or administered at appropriate levels (J. Appl. Bacteriol. 1989;66:365-78). Intestinal microflora are better understood and more frequently used than cutaneous microbiota, but researchers have recently applied the concepts underlying the efficacy of intestinal probiotics to investigate potential benefits in the dermatologic realm. This work has also been spurred by the flurry of investigations on probiotics for the treatment of atopic dermatitis (AD).
In one of the earlier studies of possible uses of probiotics for the skin, Ouwehand et al. identified strains that adhere to keratin. However, the tested microbes (Propionibacteria, selected because they are among the normal microbiota of the skin) were not found to inhibit cutaneous pathogen adhesion to human keratin. Nevertheless, the researchers concluded that additional study was warranted to identify strains that adhere in vivo and exhibit activity against potential skin pathogens (Lett. Appl. Microbiol. 2003;36:327-31).
Clearly, some probiotic strains have been shown to exhibit strong immunomodulatory activity at the cutaneous level (Eur. J. Dermatol. 2010;20:731-7). In addition, some topical skin products now contain probiotic strains as active ingredients, including Clinique Medical, which incorporates lactobacillus cultures to yield molecules that help ameliorate skin barrier effects from laser treatments or chemical peels (Facial Plast. Surg. 2009;25:285-9). Probiotics have also been used successively as adjuvant therapy to treat suppurative inflammatory conditions (i.e., boils and abscesses) in the maxilla-facial region (Stomatologiia (Mosk) 2009;88:50-2).
This column will consider some of the most current AD studies as well as other recent research. History is not to be disregarded, though. After all, the notion of topical probiotics conferring cutaneous benefits against acne and seborrhea was considered in 1912 (Gut Pathog. 2011;3:1). Current findings may, indeed, bear this out.
Atopic Dermatitis
The safety of probiotic, as well as prebiotic, treatments for AD in children was established in a long-term, randomized, double-blind trial (Clin. Dermatol. 2010;28:57-61; Pediatrics 2008;122:8-1). But questions remain regarding efficacy, with conflicting data emerging from recent studies. Given increasing interest in the use of probiotics for the treatment of AD, Boyle et al. conducted an extensive literature search up to 2008 and found that 12 trials, including 781 subjects (all children), met their inclusion criteria, with probiotics not emerging as an effective treatment for eczema (Cochrane Database Syst. Rev. 2008;CD006135).
In 2008, Betsi et al. reviewed the results of 13 relevant randomized, placebo-controlled trials, 10 of which assessed probiotics as treatment and 3 for prevention of AD. Overall, they found that probiotics, particularly Lactobacillus rhamnosus GG, appear to be effective for preventing AD, lowering its severity in half of the trials assessed though inflammatory markers were not significantly affected. The authors called for more research to determine the usefulness of probiotics in AD treatment or prevention (Am. J. Clin. Dermatol. 2008;9:93-103).
In a 2010 analysis of systematic reviews indexed between August 2007 and August 2008 covering disease prevention and atopic eczema treatment, Williams and Grindlay found two independent systematic reviews suggesting that ingestion of probiotics by mothers during pregnancy might lower the incidence of subsequent eczema. However, they noted that a review of 13 studies of probiotics for treating established eczema revealed no convincing support for its clinical use, a stance that was buttressed by a later Cochrane Review (Clin. Exp. Dermatol. 2010;35:223-7).
In 2010, Gerasimov et al. conducted a randomized, double-blind, placebo-controlled, prospective study of 90 children (1-3 years old) with moderate to severe AD treated with a mixture of L. acidophilus DDS-1 and Bifidobacterium lactis UABLA-12 with fructo-oligosaccharide (5 billion colony-forming units twice daily for 8 weeks vs. placebo). The researchers found that the use of the probiotic compound correlated with significant clinical improvement in children with AD, and suggested that additional research is necessary to assess the efficacy of probiotics in adults with AD (Am. J. Clin. Dermatol. 2010;11:351-61).
In another recent study, investigators isolated L. plantarum strains from the Korean fermented food kimchi, and found that they hindered the dermatitis promoted by house-dust mites in a mouse model representative of human AD (J. Appl. Microbiol. 2011;110:1195-202). Overall, clinical trials conducted to test the use of probiotics to treat AD over the last 15 years have yielded conflicting results, though it appears that there is not enough evidence to warrant support for such therapy (Clin. Rev. Allergy Immunol. 2011;41:267-71).
Mechanism of Action
Presently, the mechanism of action whereby skin benefits are manifested through the oral ingestion of probiotics is thought to be a downstream result of the boost in systemic immune response, especially T-cell subsets such as Th1 cells that may ultimately enhance immune responses in organs beyond the digestive tract (Clin. Plast. Surg. 2012;39:59-64; Clin. Dermatol. 2008;26:4-11).
In discussing an alternative to antibacterial products for imbalances in cutaneous microorganisms that result in mild acne, xerosis, or AD, Simmering and Breves suggest that "prebiotic actives rebalance the skin microflora while probiotic approaches predominantly consist of applying an inactivated microbial biomass of beneficial bacteria" (Hautarzt. 2009;60:809-14).
Cutaneous Immune Homeostasis
In a 2009 randomized, double-blind, placebo-controlled clinical trial with 54 volunteers, Guéniche et al. set out to ascertain whether the probiotic bacterium L. johnsonii (La1) could influence cutaneous immune homeostasis in humans after solar-simulated UV exposure (twice 1.5 MED [minimal erythema dose]). They showed that La1 consumption contributed to hastening the recovery of allostimulatory function in epidermal cells (Dermatoendocrinol. 2009;1:275-9).
Previously, in 2008, Peguet-Navarro et al. conducted a randomized, double-blind, placebo-controlled clinical trial in 54 healthy volunteers to study the potential impact of oral supplementation with La1 on skin immune status after UV exposure. Subjects received either La1 or placebo during the 6 weeks prior to solar-simulated UV exposure. The investigators found on day 4 after exposure that the allostimulatory capacity of epidermal cells had completely recovered in the La1 group correlating with the normalization of epidermal CD1a expression. They concluded that ingested probiotic bacteria hasten the recovery of skin immune homeostasis after UV-provoked immunosuppression (Eur. J. Dermatol. 2008;18:504-11).
Anti-inflammatory Activity
In 2010, Guéniche et al. demonstrated that B. longum can reduce skin inflammation mediated by substance P (Exp. Dermatol. 2010;19:e1-8). In a separate study, some of the same investigators found that L. paracasei appears to have the capacity to confer benefits related to barrier function and skin reactivity, also blunting the effects of substance P–induced skin inflammation (Eur. J. Dermatol. 2010;20:731-7).
Antiphotoaging Activity
In 2010, Bouilly-Gauthier et al. evaluated the effects of a dietary supplement combining L. johnsonii (La1), which is thought to protect the skin immune system after UV exposure, and nutritional doses of carotenoids on early UV-induced skin damage. They performed three clinical trials using various UV sources (non–extreme UV with a high UVA irradiance, extreme simulated solar radiation, and natural sunlight) in 139 healthy women over age 18 with skin type II-IV. The investigators found over the 10 weeks of the study that the combination of probiotic (La1) and nutritional doses of carotenoids lowered early UV-induced skin damage caused by simulated or natural sun exposure. Further study of the possible long-term effects against UV exposure and photoaging is warranted, they concluded (Br. J. Dermatol. 2010;163:536-43).
Topical Uses
In a study more than a decade ago, Di Marzio et al. showed that the topical application of a cream containing Streptococcus thermophilus, an organism found in most yogurts, raised the production of ceramides, which is notable given the anti-inflammatory activity and antimicrobial activity of some ceramides against Proprionibacterium acnes (J. Invest. Dermatol. 1999;113:98-106;Gut Pathog. 2011;3:1). Two recent in vitro studies have also revealed that probiotics can have antibacterial activity against P. acnes (Int. J. Cosmet. Sci. 2010;32:139-42; J. Microbiol. 2009;47:101-9). The prospects for efficacy of topically applied probiotics in the prevention and treatment of pro-inflammatory immune reactions are considered, by some, to be promising, however (Hautarzt. 2009;60:795-801). And, in fact, Guéniche et al. have found that the topical application of Vitreoscilla filiformis demonstrated efficacy against seborrheic dermatitis and AD (J. Eur. Acad. Dermatol. Venereol. 2008;22:1014-5; Eur. J. Dermatol. 2006;16:380-4).
Conclusion
While still controversial, the findings of probiotics’ effects in the treatment of atopic dermatitis remain compelling. Even more interesting, though, is the current work that suggests additional potential applications of probiotics in the dermatologic armamentarium. The work is in its early stages, but results warrant additional research, at the very least, if not cause for optimism over the prospect of more supportive evidence.
Dr. Baumann is in private practice in Miami Beach. She did not disclose any conflicts of interest.
Probiotics are live microorganisms that impart health benefits to the host when present or administered at appropriate levels (J. Appl. Bacteriol. 1989;66:365-78). Intestinal microflora are better understood and more frequently used than cutaneous microbiota, but researchers have recently applied the concepts underlying the efficacy of intestinal probiotics to investigate potential benefits in the dermatologic realm. This work has also been spurred by the flurry of investigations on probiotics for the treatment of atopic dermatitis (AD).
In one of the earlier studies of possible uses of probiotics for the skin, Ouwehand et al. identified strains that adhere to keratin. However, the tested microbes (Propionibacteria, selected because they are among the normal microbiota of the skin) were not found to inhibit cutaneous pathogen adhesion to human keratin. Nevertheless, the researchers concluded that additional study was warranted to identify strains that adhere in vivo and exhibit activity against potential skin pathogens (Lett. Appl. Microbiol. 2003;36:327-31).
Clearly, some probiotic strains have been shown to exhibit strong immunomodulatory activity at the cutaneous level (Eur. J. Dermatol. 2010;20:731-7). In addition, some topical skin products now contain probiotic strains as active ingredients, including Clinique Medical, which incorporates lactobacillus cultures to yield molecules that help ameliorate skin barrier effects from laser treatments or chemical peels (Facial Plast. Surg. 2009;25:285-9). Probiotics have also been used successively as adjuvant therapy to treat suppurative inflammatory conditions (i.e., boils and abscesses) in the maxilla-facial region (Stomatologiia (Mosk) 2009;88:50-2).
This column will consider some of the most current AD studies as well as other recent research. History is not to be disregarded, though. After all, the notion of topical probiotics conferring cutaneous benefits against acne and seborrhea was considered in 1912 (Gut Pathog. 2011;3:1). Current findings may, indeed, bear this out.
Atopic Dermatitis
The safety of probiotic, as well as prebiotic, treatments for AD in children was established in a long-term, randomized, double-blind trial (Clin. Dermatol. 2010;28:57-61; Pediatrics 2008;122:8-1). But questions remain regarding efficacy, with conflicting data emerging from recent studies. Given increasing interest in the use of probiotics for the treatment of AD, Boyle et al. conducted an extensive literature search up to 2008 and found that 12 trials, including 781 subjects (all children), met their inclusion criteria, with probiotics not emerging as an effective treatment for eczema (Cochrane Database Syst. Rev. 2008;CD006135).
In 2008, Betsi et al. reviewed the results of 13 relevant randomized, placebo-controlled trials, 10 of which assessed probiotics as treatment and 3 for prevention of AD. Overall, they found that probiotics, particularly Lactobacillus rhamnosus GG, appear to be effective for preventing AD, lowering its severity in half of the trials assessed though inflammatory markers were not significantly affected. The authors called for more research to determine the usefulness of probiotics in AD treatment or prevention (Am. J. Clin. Dermatol. 2008;9:93-103).
In a 2010 analysis of systematic reviews indexed between August 2007 and August 2008 covering disease prevention and atopic eczema treatment, Williams and Grindlay found two independent systematic reviews suggesting that ingestion of probiotics by mothers during pregnancy might lower the incidence of subsequent eczema. However, they noted that a review of 13 studies of probiotics for treating established eczema revealed no convincing support for its clinical use, a stance that was buttressed by a later Cochrane Review (Clin. Exp. Dermatol. 2010;35:223-7).
In 2010, Gerasimov et al. conducted a randomized, double-blind, placebo-controlled, prospective study of 90 children (1-3 years old) with moderate to severe AD treated with a mixture of L. acidophilus DDS-1 and Bifidobacterium lactis UABLA-12 with fructo-oligosaccharide (5 billion colony-forming units twice daily for 8 weeks vs. placebo). The researchers found that the use of the probiotic compound correlated with significant clinical improvement in children with AD, and suggested that additional research is necessary to assess the efficacy of probiotics in adults with AD (Am. J. Clin. Dermatol. 2010;11:351-61).
In another recent study, investigators isolated L. plantarum strains from the Korean fermented food kimchi, and found that they hindered the dermatitis promoted by house-dust mites in a mouse model representative of human AD (J. Appl. Microbiol. 2011;110:1195-202). Overall, clinical trials conducted to test the use of probiotics to treat AD over the last 15 years have yielded conflicting results, though it appears that there is not enough evidence to warrant support for such therapy (Clin. Rev. Allergy Immunol. 2011;41:267-71).
Mechanism of Action
Presently, the mechanism of action whereby skin benefits are manifested through the oral ingestion of probiotics is thought to be a downstream result of the boost in systemic immune response, especially T-cell subsets such as Th1 cells that may ultimately enhance immune responses in organs beyond the digestive tract (Clin. Plast. Surg. 2012;39:59-64; Clin. Dermatol. 2008;26:4-11).
In discussing an alternative to antibacterial products for imbalances in cutaneous microorganisms that result in mild acne, xerosis, or AD, Simmering and Breves suggest that "prebiotic actives rebalance the skin microflora while probiotic approaches predominantly consist of applying an inactivated microbial biomass of beneficial bacteria" (Hautarzt. 2009;60:809-14).
Cutaneous Immune Homeostasis
In a 2009 randomized, double-blind, placebo-controlled clinical trial with 54 volunteers, Guéniche et al. set out to ascertain whether the probiotic bacterium L. johnsonii (La1) could influence cutaneous immune homeostasis in humans after solar-simulated UV exposure (twice 1.5 MED [minimal erythema dose]). They showed that La1 consumption contributed to hastening the recovery of allostimulatory function in epidermal cells (Dermatoendocrinol. 2009;1:275-9).
Previously, in 2008, Peguet-Navarro et al. conducted a randomized, double-blind, placebo-controlled clinical trial in 54 healthy volunteers to study the potential impact of oral supplementation with La1 on skin immune status after UV exposure. Subjects received either La1 or placebo during the 6 weeks prior to solar-simulated UV exposure. The investigators found on day 4 after exposure that the allostimulatory capacity of epidermal cells had completely recovered in the La1 group correlating with the normalization of epidermal CD1a expression. They concluded that ingested probiotic bacteria hasten the recovery of skin immune homeostasis after UV-provoked immunosuppression (Eur. J. Dermatol. 2008;18:504-11).
Anti-inflammatory Activity
In 2010, Guéniche et al. demonstrated that B. longum can reduce skin inflammation mediated by substance P (Exp. Dermatol. 2010;19:e1-8). In a separate study, some of the same investigators found that L. paracasei appears to have the capacity to confer benefits related to barrier function and skin reactivity, also blunting the effects of substance P–induced skin inflammation (Eur. J. Dermatol. 2010;20:731-7).
Antiphotoaging Activity
In 2010, Bouilly-Gauthier et al. evaluated the effects of a dietary supplement combining L. johnsonii (La1), which is thought to protect the skin immune system after UV exposure, and nutritional doses of carotenoids on early UV-induced skin damage. They performed three clinical trials using various UV sources (non–extreme UV with a high UVA irradiance, extreme simulated solar radiation, and natural sunlight) in 139 healthy women over age 18 with skin type II-IV. The investigators found over the 10 weeks of the study that the combination of probiotic (La1) and nutritional doses of carotenoids lowered early UV-induced skin damage caused by simulated or natural sun exposure. Further study of the possible long-term effects against UV exposure and photoaging is warranted, they concluded (Br. J. Dermatol. 2010;163:536-43).
Topical Uses
In a study more than a decade ago, Di Marzio et al. showed that the topical application of a cream containing Streptococcus thermophilus, an organism found in most yogurts, raised the production of ceramides, which is notable given the anti-inflammatory activity and antimicrobial activity of some ceramides against Proprionibacterium acnes (J. Invest. Dermatol. 1999;113:98-106;Gut Pathog. 2011;3:1). Two recent in vitro studies have also revealed that probiotics can have antibacterial activity against P. acnes (Int. J. Cosmet. Sci. 2010;32:139-42; J. Microbiol. 2009;47:101-9). The prospects for efficacy of topically applied probiotics in the prevention and treatment of pro-inflammatory immune reactions are considered, by some, to be promising, however (Hautarzt. 2009;60:795-801). And, in fact, Guéniche et al. have found that the topical application of Vitreoscilla filiformis demonstrated efficacy against seborrheic dermatitis and AD (J. Eur. Acad. Dermatol. Venereol. 2008;22:1014-5; Eur. J. Dermatol. 2006;16:380-4).
Conclusion
While still controversial, the findings of probiotics’ effects in the treatment of atopic dermatitis remain compelling. Even more interesting, though, is the current work that suggests additional potential applications of probiotics in the dermatologic armamentarium. The work is in its early stages, but results warrant additional research, at the very least, if not cause for optimism over the prospect of more supportive evidence.
Dr. Baumann is in private practice in Miami Beach. She did not disclose any conflicts of interest.
Probiotics are live microorganisms that impart health benefits to the host when present or administered at appropriate levels (J. Appl. Bacteriol. 1989;66:365-78). Intestinal microflora are better understood and more frequently used than cutaneous microbiota, but researchers have recently applied the concepts underlying the efficacy of intestinal probiotics to investigate potential benefits in the dermatologic realm. This work has also been spurred by the flurry of investigations on probiotics for the treatment of atopic dermatitis (AD).
In one of the earlier studies of possible uses of probiotics for the skin, Ouwehand et al. identified strains that adhere to keratin. However, the tested microbes (Propionibacteria, selected because they are among the normal microbiota of the skin) were not found to inhibit cutaneous pathogen adhesion to human keratin. Nevertheless, the researchers concluded that additional study was warranted to identify strains that adhere in vivo and exhibit activity against potential skin pathogens (Lett. Appl. Microbiol. 2003;36:327-31).
Clearly, some probiotic strains have been shown to exhibit strong immunomodulatory activity at the cutaneous level (Eur. J. Dermatol. 2010;20:731-7). In addition, some topical skin products now contain probiotic strains as active ingredients, including Clinique Medical, which incorporates lactobacillus cultures to yield molecules that help ameliorate skin barrier effects from laser treatments or chemical peels (Facial Plast. Surg. 2009;25:285-9). Probiotics have also been used successively as adjuvant therapy to treat suppurative inflammatory conditions (i.e., boils and abscesses) in the maxilla-facial region (Stomatologiia (Mosk) 2009;88:50-2).
This column will consider some of the most current AD studies as well as other recent research. History is not to be disregarded, though. After all, the notion of topical probiotics conferring cutaneous benefits against acne and seborrhea was considered in 1912 (Gut Pathog. 2011;3:1). Current findings may, indeed, bear this out.
Atopic Dermatitis
The safety of probiotic, as well as prebiotic, treatments for AD in children was established in a long-term, randomized, double-blind trial (Clin. Dermatol. 2010;28:57-61; Pediatrics 2008;122:8-1). But questions remain regarding efficacy, with conflicting data emerging from recent studies. Given increasing interest in the use of probiotics for the treatment of AD, Boyle et al. conducted an extensive literature search up to 2008 and found that 12 trials, including 781 subjects (all children), met their inclusion criteria, with probiotics not emerging as an effective treatment for eczema (Cochrane Database Syst. Rev. 2008;CD006135).
In 2008, Betsi et al. reviewed the results of 13 relevant randomized, placebo-controlled trials, 10 of which assessed probiotics as treatment and 3 for prevention of AD. Overall, they found that probiotics, particularly Lactobacillus rhamnosus GG, appear to be effective for preventing AD, lowering its severity in half of the trials assessed though inflammatory markers were not significantly affected. The authors called for more research to determine the usefulness of probiotics in AD treatment or prevention (Am. J. Clin. Dermatol. 2008;9:93-103).
In a 2010 analysis of systematic reviews indexed between August 2007 and August 2008 covering disease prevention and atopic eczema treatment, Williams and Grindlay found two independent systematic reviews suggesting that ingestion of probiotics by mothers during pregnancy might lower the incidence of subsequent eczema. However, they noted that a review of 13 studies of probiotics for treating established eczema revealed no convincing support for its clinical use, a stance that was buttressed by a later Cochrane Review (Clin. Exp. Dermatol. 2010;35:223-7).
In 2010, Gerasimov et al. conducted a randomized, double-blind, placebo-controlled, prospective study of 90 children (1-3 years old) with moderate to severe AD treated with a mixture of L. acidophilus DDS-1 and Bifidobacterium lactis UABLA-12 with fructo-oligosaccharide (5 billion colony-forming units twice daily for 8 weeks vs. placebo). The researchers found that the use of the probiotic compound correlated with significant clinical improvement in children with AD, and suggested that additional research is necessary to assess the efficacy of probiotics in adults with AD (Am. J. Clin. Dermatol. 2010;11:351-61).
In another recent study, investigators isolated L. plantarum strains from the Korean fermented food kimchi, and found that they hindered the dermatitis promoted by house-dust mites in a mouse model representative of human AD (J. Appl. Microbiol. 2011;110:1195-202). Overall, clinical trials conducted to test the use of probiotics to treat AD over the last 15 years have yielded conflicting results, though it appears that there is not enough evidence to warrant support for such therapy (Clin. Rev. Allergy Immunol. 2011;41:267-71).
Mechanism of Action
Presently, the mechanism of action whereby skin benefits are manifested through the oral ingestion of probiotics is thought to be a downstream result of the boost in systemic immune response, especially T-cell subsets such as Th1 cells that may ultimately enhance immune responses in organs beyond the digestive tract (Clin. Plast. Surg. 2012;39:59-64; Clin. Dermatol. 2008;26:4-11).
In discussing an alternative to antibacterial products for imbalances in cutaneous microorganisms that result in mild acne, xerosis, or AD, Simmering and Breves suggest that "prebiotic actives rebalance the skin microflora while probiotic approaches predominantly consist of applying an inactivated microbial biomass of beneficial bacteria" (Hautarzt. 2009;60:809-14).
Cutaneous Immune Homeostasis
In a 2009 randomized, double-blind, placebo-controlled clinical trial with 54 volunteers, Guéniche et al. set out to ascertain whether the probiotic bacterium L. johnsonii (La1) could influence cutaneous immune homeostasis in humans after solar-simulated UV exposure (twice 1.5 MED [minimal erythema dose]). They showed that La1 consumption contributed to hastening the recovery of allostimulatory function in epidermal cells (Dermatoendocrinol. 2009;1:275-9).
Previously, in 2008, Peguet-Navarro et al. conducted a randomized, double-blind, placebo-controlled clinical trial in 54 healthy volunteers to study the potential impact of oral supplementation with La1 on skin immune status after UV exposure. Subjects received either La1 or placebo during the 6 weeks prior to solar-simulated UV exposure. The investigators found on day 4 after exposure that the allostimulatory capacity of epidermal cells had completely recovered in the La1 group correlating with the normalization of epidermal CD1a expression. They concluded that ingested probiotic bacteria hasten the recovery of skin immune homeostasis after UV-provoked immunosuppression (Eur. J. Dermatol. 2008;18:504-11).
Anti-inflammatory Activity
In 2010, Guéniche et al. demonstrated that B. longum can reduce skin inflammation mediated by substance P (Exp. Dermatol. 2010;19:e1-8). In a separate study, some of the same investigators found that L. paracasei appears to have the capacity to confer benefits related to barrier function and skin reactivity, also blunting the effects of substance P–induced skin inflammation (Eur. J. Dermatol. 2010;20:731-7).
Antiphotoaging Activity
In 2010, Bouilly-Gauthier et al. evaluated the effects of a dietary supplement combining L. johnsonii (La1), which is thought to protect the skin immune system after UV exposure, and nutritional doses of carotenoids on early UV-induced skin damage. They performed three clinical trials using various UV sources (non–extreme UV with a high UVA irradiance, extreme simulated solar radiation, and natural sunlight) in 139 healthy women over age 18 with skin type II-IV. The investigators found over the 10 weeks of the study that the combination of probiotic (La1) and nutritional doses of carotenoids lowered early UV-induced skin damage caused by simulated or natural sun exposure. Further study of the possible long-term effects against UV exposure and photoaging is warranted, they concluded (Br. J. Dermatol. 2010;163:536-43).
Topical Uses
In a study more than a decade ago, Di Marzio et al. showed that the topical application of a cream containing Streptococcus thermophilus, an organism found in most yogurts, raised the production of ceramides, which is notable given the anti-inflammatory activity and antimicrobial activity of some ceramides against Proprionibacterium acnes (J. Invest. Dermatol. 1999;113:98-106;Gut Pathog. 2011;3:1). Two recent in vitro studies have also revealed that probiotics can have antibacterial activity against P. acnes (Int. J. Cosmet. Sci. 2010;32:139-42; J. Microbiol. 2009;47:101-9). The prospects for efficacy of topically applied probiotics in the prevention and treatment of pro-inflammatory immune reactions are considered, by some, to be promising, however (Hautarzt. 2009;60:795-801). And, in fact, Guéniche et al. have found that the topical application of Vitreoscilla filiformis demonstrated efficacy against seborrheic dermatitis and AD (J. Eur. Acad. Dermatol. Venereol. 2008;22:1014-5; Eur. J. Dermatol. 2006;16:380-4).
Conclusion
While still controversial, the findings of probiotics’ effects in the treatment of atopic dermatitis remain compelling. Even more interesting, though, is the current work that suggests additional potential applications of probiotics in the dermatologic armamentarium. The work is in its early stages, but results warrant additional research, at the very least, if not cause for optimism over the prospect of more supportive evidence.
Dr. Baumann is in private practice in Miami Beach. She did not disclose any conflicts of interest.
