ArticlePDF AvailableLiterature Review

The Role of Probiotics in Skin Care: Advances, Challenges, and Future Needs

July 2024
Probiotics and Antimicrobial Proteins 16(6):2132-2149

DOI:10.1007/s12602-024-10319-y

Authors:

Faezeh Shirkhan

Islamic Azad University Pharmaceutical Sciences Branch

Fatemeh Safaei

Iranian Research Organization for Science and Technology

Saeed Mirdamadi

Iranian Research Organization for Science and Technology

Mohammad Zandi

Iranian Research Organization for Science and Technology

The skin, being the largest organ in the human body, plays a pivotal role in safeguarding the body against invasive pathogens. Therefore, it is essential to reinforce and protect this vital organ. Current research supports the impact of probiotics on skin health and their ability to alleviate various skin disorders. However, the effectiveness and probable side effects of probiotics in skin care remain a subject of debate, necessitating further investigation and analysis. Hence, this study aims to highlight existing gaps and future needs in the current research on probiotics in skin care and pave the way for future investigations. Therefore, we scrutinized the effects of oral (fermented foods and dietary supplements) and non-oral/topical probiotics on skin care, and the mechanism of probiotics that affect skin health. The results of most studies showed that fermented foods containing probiotics, particularly dairy products, positively impact skin health. The research results regarding the efficacy of probiotic supplements and live strains in treating skin disorders show promising potential. However, safety evaluations are crucial, to identify any potential adverse effects. While research has identified numerous potential mechanisms by which probiotics may influence skin health, a complete understanding of their precise mode of action remains elusive. However, it seems that probiotics can exert their positive effects through the gut-skin and gut-skin-brain axis on the human body. Therefore, following the identification of safe probiotics, additional studies should be carried out to establish optimal dosages, potential side effects, suitable regulatory guidelines, and validation methods.

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Some of the effects of oral probiotics in skin care

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Probiotics and Antimicrobial Proteins

https://doi.org/10.1007/s12602-024-10319-y

REVIEW

The Role ofProbiotics inSkin Care: Advances, Challenges, andFuture Needs

FaezehShirkhan1· FatemehSafaei2· SaeedMirdamadi3 · MohammadZandi4

Accepted: 27 June 2024

Abstract

The skin, being the largest organ in the human body, plays a pivotal role in safeguarding the body against invasive pathogens.

Therefore, it is essential to reinforce and protect this vital organ. Current research supports the impact of probiotics on skin

health and their ability to alleviate various skin disorders. However, the effectiveness and probable side effects of probiotics

in skin care remain a subject of debate, necessitating further investigation and analysis. Hence, this study aims to highlight

existing gaps and future needs in the current research on probiotics in skin care and pave the way for future investigations.

Therefore, we scrutinized the effects of oral (fermented foods and dietary supplements) and non-oral/topical probiotics on

skin care, and the mechanism of probiotics that affect skin health. The results of most studies showed that fermented foods

containing probiotics, particularly dairy products, positively impact skin health. The research results regarding the efficacy

of probiotic supplements and live strains in treating skin disorders show promising potential. However, safety evaluations

are crucial, to identify any potential adverse effects. While research has identified numerous potential mechanisms by which

probiotics may influence skin health, a complete understanding of their precise mode of action remains elusive. However,

it seems that probiotics can exert their positive effects through the gut-skin and gut-skin-brain axis on the human body.

Therefore, following the identification of safe probiotics, additional studies should be carried out to establish optimal dos-

ages, potential side effects, suitable regulatory guidelines, and validation methods.

Keywords Probiotics· Skin care· Fermented food· Dietary supplements· Mechanism of action

Introduction

Human skin is always at risk of damage due to long-term

external exposure to various factors [1]. Skin disorders may

be triggered by imbalances in the gut microbiome [2]. The

connection between skin health and digestive system health

has been proven by various reports and numerous studies

[2]. The gut-skin axis is influenced by diet, ultraviolet B

(UVB) radiation, and local allergens that affect the gut [3].

Therefore, the interconnectedness between the gut and the

skin is a crucial factor to be taken into account in the man-

agement and treatment of skin disorders [4]. Given the con-

cerns surrounding the side effects of dermal products, there

is a pressing need to explore new, chemical-free, and natural

treatment approaches [2]. Various studies have indicated that

probiotics and their metabolites influence treating skin dis-

orders. Hence, probiotics as an appropriate remedy are the

natural option to strengthen the skin microflora [5]. Probi-

otics are live microorganisms that when consumed in ade-

quate quantity provide health benefits to the host [6]. Most

probiotics are Lactobacillus (L) and Bifidobacterium (Bif)

* Saeed Mirdamadi

Mirdamadi@irost.ir

* Mohammad Zandi

MZ1075@IROST.IR

Faezeh Shirkhan

Shirkhanf69@gmail.com

Fatemeh Safaei

fatemeh.safaie7@gmail.com

1 Department ofFood Science andTechnology, Faculty

ofPharmacy, Tehran Medical Sciences, Islamic Azad

University, Tehran19496-35881, Iran

2 Iranian Research Organization forScience andTechnology,

Microbial Biotechnology Student inIranian Research

Organization forScience andTechnology, Microbial

biotechnology, Tehran3353511, Iran

3 Department ofBiotechnology, Iranian Research Organization

forScience & Technology (IROST), Tehran33131-93685,

Iran

4 Department ofAgriculture, Iranian Research Organization

forScience andTechnology (IROST), Tehran3353511, Iran

Probiotics and Antimicrobial Proteins

species or yeast species (saccharomyces). Probiotics have

been shown to influence the intestinal microbiome and have

proven effective in addressing certain skin conditions [7].

Nowadays, probiotics are included in cosmetic and skin care

products to enhance beauty, improve function, and treat skin

disorders [4]. Hence, it has been reported that they have the

potential for wound healing, skin rejuvenation, radiation pro-

tection, and improving skin immunity [8]. Aside from their

direct advantages for the skin, probiotics have been identi-

fied to possess anti-inflammatory qualities, making them

advantageous in managing skin conditions associated with

inflammation [9]. The probiotics in fermented foods can be

effective in the human diet and their impact on gut microbi-

ota and health [10]. Some studies have indicated the effect of

fermented products on skin health. A review study has stated

the positive effect of fermented dairy products on skin care

and treatment [11]. In a study, the researchers reported that

the daily consumption of fermented pomegranate extracts

with Saccharomyces cerevisiae and Lactobacillus plantarum

can protect the skin against oxidative stress and slow skin

aging [12]. Another study has reported that kimchi can sup-

press atopic dermatitis (AD)-like skin lesions and epidermal

thickening, in house dust mite-induced dermatitis in mice

[13]. Probiotics are not limited to topical applications in skin

care products; they also include oral supplements, showing

promising results in improving skin conditions internally [6].

Currently, investigations into the potential advantages of oral

probiotics have piqued curiosity in evaluating their effective-

ness as a topical remedy [14, 15]. There are limited studies

about the efficacy of oral or topically applied probiotics in

skin care products [16]. Moreover, our understanding of the

mechanisms through which probiotics impact the gut-skin

axis remains limited. There is little data on how probiotics

in fermented products may influence skin care. Hence, this

study reviews the scientific evidence and presents current

research on the effect of probiotics on strengthening, caring

for, and treating skin, attempting to discuss the existing chal-

lenges to identify the potential applications of probiotics.

We aim that this review demonstrates the role of oral and

topical probiotics in skin care and treatment and highlights

important areas that require further research and exploration.

The Importance ofSkin Care

Human skin has layers including the epidermis, dermis, and

subcutaneous tissue. The epidermis layer comprised some

subtype cells as well as keratinocytes, melanocytes, Langer-

hans cells, etc. The layer dermis has extracellular matrix pro-

teins, growth factors, and dermal fibroblasts. In addition, the

subcutaneous layer, also known as the hypoderm, comprises

mesenchymal stem cells and connective tissue [17]. These

layers are in charge of protecting against various types of

stress [18]. Long-term exposure to both internal and external

stresses can have a significant impact on the skin. Figure1

shows the factors effective on the skin care. Stresses such

as improper nutrition, insufficient sleep, smoking, alcohol

consumption, vitamin deficiency, and genetic disorders can

impact the skin’s health. External factors such as radiation,

air pollution, pathogenic bacteria, heavy metals, and atmos-

pheric particles can also cause skin abnormalities such as

skin aging, pigmented dermatosis, immune system-induced

dermatoses, connective tissue diseases, and poor skin heal-

ing after injuries [19]. Hence, it is essential to consider the

skin’s structure, factors causing the disease, symptoms, diag-

nosis, treatment and prevention, and skin care.

Probiotics inSkin Care

Today, the use of probiotics in improving and treating skin

is an attractive alternative to prevent inflammatory disor-

ders and solve skin problems [20]. A considerable variety of

microbial species and groups have been recognized for their

probiotic characteristics [21]. Table1 illustrates the different

types of probiotics used in the skin.

Humans can benefit from the probiotics in fermented

foods and its benefits through the stomach. Several studies

have been conducted on the effects of fermented foods on the

gut and health [10, 16]. Probiotics used in skin care, can be

ingested orally in the form of fermented foods and supple-

ments. Probiotic supplements are another way to change the

microbiome and affect the skin [22]. Additionally, probiotics

can also be applied topically in a non-oral form to enhance

skin health [22]. Probiotic non-oral topical products aim to

accelerate and improve skin health, solving skin problems

(such as acne, atopic dermatitis, rosacea, psoriasis, skin can-

cer, and wounds), improving skin appearance (such as anti-

aging, anti-wrinkle, moisturizing, and skin treatment), or

preventing skin problems [22]. Figure2 shows the probiotics

can also be used oral and non-oral in skin care products.

The Role ofOral Probiotics inSkin Care

Oral probiotics can protect skin cells and are used in the treat-

ment of other skin diseases by regulating the skin microbiota

and gut–skin axis [9]. Depending on the type, isolation source,

concentration, and production conditions, probiotics can exert

specific mechanisms to affect the skin. In Fig.3, some of the

effects of oral probiotics in skin care are presented.

Effect ofFermented Foods inSkin Care

Lactic acid bacteria have a significant contribution in the

preparation of many fermented products. The quantity of

Probiotics and Antimicrobial Proteins

live bacteria in fermented foods may vary widely based

on the production and processing methods, as well as the

conditions and duration of storage [23]. The effect of fer-

mented foods and its mechanism on human skin are sum-

marized in Table2.

Based on the reviews summarized in Table2, it is clear that

probiotic fermented foods affect skin cells, and this effect may

be due to the fermentation process itself. Fermentation is a

metabolic process that involves the conversion of sugars into

acids, gases, and alcohol [32]. Fermented products and pro-

biotics can have several positive effects on health. They may

help to strengthen the intestinal mucosal barrier, regulate the

immune system, inhibit pathogens, aid in essential enzymatic

reactions, and produce metabolites. These effects can help

enhance the gut skin and skin health [11].

Based on the findings presented in Table2, it is evident

that fermented dairy products have been extensively stud-

ied. For instance, consuming edible yogurt containing L.

Fig. 1 Diagram of the skin, skin lesions, and factors eﬀective on skin care

Table 1 Typical strains of probiotics [21]

Lactobacillus (L) Biﬁdobacterium

(Bif) Enteroccus (E) Streptococcus

(Strep/S) Lactococcus

(Lactis) Propionibacterrium

(P) Yeast

L. acidophilus

L. breve

L. casei

L. cuvatus

L. fermentum

L. gasseri

L. johnsonii

L. reuteri

L. rhamnosus

L. salivarius

Bif. adolescentis

Bif. animalis

Bif. breve

Bif. infantis

Bif. longum

Bif. thermophilum

E. faecalis

E. faecium Strep

thermophilus Lactis subsp. cre-

moris

Lactis subsp. lactis

P. freudenreichii

P. freudenrechill

subsp. Shermanii

P. jensenii

Kluyveromyces lactis

(K. lactis)

Saccharomyces bou-

lardi (S. boulardii)

Saccharomyces

cerevisiae (S. cer-

evisiae)

Others:

Leuconostoc mesenteroides

Pediococcus acidolactis

Probiotics and Antimicrobial Proteins

delbrueckii and Streptococcus thermophilus for 4 weeks

has been shown to enhance skin elasticity and reduce dry-

ness of women’s cheeks [33]. Similarly, the oral consump-

tion of whey fermented with L. helveticus has been found

to improve the function of the epidermal barrier, thereby

preventing the onset of dermatitis [34]. Furthermore, infants

fed with a hydrolyzed form of whey protein demonstrated

a decrease in symptoms of atopic dermatitis compared to a

control group [35]. Additionally, fermented dairy products

such as kefir can improve atopic dermatitis by strengthening

the skin’s function and water balance even in healthy skin

[36, 37]. This is due to the suitability of dairy products as a

substrate for the growth of probiotic bacteria. However, it is

still unclear whether consuming oral or topical applications

of fermented dairy products is more beneficial for skin care.

Some researchers believe that consuming fermented dairy

products may have unique benefits in modulating gut micro-

biota while applying them topically may directly modulate

skin flora and inflammation. Despite this, many studies

suggest that consuming probiotics is effective in improving

skin health, maintaining skin homeostasis, and regulating

the skin’s immune system. As a result, oral probiotics are

now considered a treatment option in skin care [11]. In addi-

tion to clinical studies, the effect of probiotics has also been

reported on skin cells. Table3 briefly presents some of these

studies and their mechanisms of action.

Based on the findings presented in Table3, it is evident

that more studies have focused on dairy products, particu-

larly fermented milk [50]. One study reported that milk

fermented by L. helveticus NS8 (NS8-FS) was effective in

inhibiting tyrosinase enzyme activity in B16F10 cells and

reduced melanin content by almost 40% [51].

After comparing and examining various studies on differ-

ent strains of skin cells, it has been found that the L. plan-

tarum strain has excellent probiotic effects on skin cells [52].

Studies have also shown that the ethanolic extract of soybean

milk fermented with L. plantarum TWK10 strain has anti-

melanogenic properties [42]. Another study has found that

the metabolite derived from L. plantarum TWK10 in fer-

mented soybean milk has anti-melanogenic effects in B16F0

mouse melanoma cells [41]. Additionally, two metabolites,

Daidzein and Equol, obtained from soy milk fermented with

L. plantarum strain TWK10, have also shown anti-melanogenic

effects in mouse melanoma cells [53]. Moreover, the L.

Fig. 2 The use of probiotics on skin care products

Probiotics and Antimicrobial Proteins

plantarum M23 strain isolated from raw milk has better

tyrosinase inhibitory activity compared to commercial lac-

tic acid bacteria with numerous reports on the effectiveness

of the L. plantarum strain in treating skin disorders, it is

evident that this strain has immense potential in the produc-

tion of skin care products [50]. Studies have shown that fer-

mented foods containing probiotics can protect the skin from

damage [3]. However, it is unclear whether this finding is

associated with food substrate, the probiotic strain, or both.

To find the answer, we explored the studies on the effect of

probiotic strains in culture medium, after fermentation, and

before being added to food substrates [54].

Table4 lists various studies that demonstrate the beneficial

effects of the L. rhamnosus bacterial strain on skin cells. This

particular strain is noteworthy because it has a high lactic acid

production capacity. Additionally, it has been reported that fer-

mented rice with L. rhamnosus and Saccharomyces cerevisiae

strains can effectively inhibit the tyrosinase enzyme. Further-

more, the supernatant produced by the L. rhamnosus strain

alone was found to have a 71.3% tyrosinase inhibitory capac-

ity, even after being heated to 100 °C for 30 min. The ability to

inhibit tyrosinase showed no difference compared to the previ-

ous results [55]. In a study, it was found that lactic acid can

inhibit the inhibitory activity of tyrosine in a dose-dependent

manner [51]. Some research have demonstrated that lactic acid

can play a role in increasing the thickness of the epidermis,

reducing melanin deposition, and regulating collagen levels

[54, 56]. Therefore, it is important to determine the function

of the strain alone and in the food substrate to identify effec-

tive strains for skin care. One study found that Leuconostoc

autolysis extracted from Kimoto reduced melanin content in

B16F0 murine melanoma cells by inhibiting tyrosinase activ-

ity. However, it was not able to do so in cell-free conditions.

Despite this limitation, the ability of autolysis to reduce mela-

nin content has led to its recognition as an anti-melanogenic

agent [57]. These results indicate that probiotic strains have a

high functional potential for improving skin health, particu-

larly in the production of natural melanogenesis inhibitors. In

addition, this suggests that probiotic strains are effective even

before being added to food substrates.

Function ofProbiotic Supplements inSkin Care

Probiotic supplements are used to maintain skin health and

as adjuvant or alternative treatment for skin diseases [62].

Table5 presents some of the relevant studies.

Table5 reveals that a limited number of studies have

investigated the complementary effect of probiotics on acne.

The first study investigating the effect of probiotics on acne

dates back to 1961. In this study, 300 patients consumed a

commercial probiotic Laxtinex, which contained L. acido-

philus and L. bulgaricus, for 16 days [84]. The results indi-

cated that 80% of acne sufferers were cured. These findings

highlight the connection between the skin manifestations of

Fig. 3 Some of the eﬀects of

oral probiotics in skin care

Probiotics and Antimicrobial Proteins

Table 2 The eﬀect of probiotics in fermented foods on human skin

Microorganism Fermented food Under treatment people and period Skin disorders/normal Mechanism of action Ref

L. bulgaricus, S. thermophilus Fermented milk + lactoferrin 56 people during 2 weeks studied

by double-blind, placebo-

controlled study

Acne vulgaris - Decreased the symptoms of acne

- Decrease of triacylglycerols in

skin surface lipids

[24]

L. casei, L. bulgaricus, S.

thermophilus Fermented milk + borage oil + green

tea, Vit E

72 healthy women during 6

months studied by double-blind

randomized clinical study

Barrier function Improved stratum corneum barrier

function

[25]

Bif. animalis ssp. lactis LKM512 Yogurt 10 adults (four males and six

females) during 4 weeks studied

by double-blind randomized

clinical, crossover study

Atopic dermatitis - Increased metabolites, including

the polyamine spermidine (SMD)

and the short-chain fatty acid

butyrate lead to a better balance of

Th1-type cells versus Th-2-type

cells

[26]

L. delbrueckii ssp. bulgaricus 2038,

S. thermophilus 1131

Yogurt and the other with added

collagen peptide and ceramid

Women during 4 weeks Chronic constipation and dry skin Improved skin elasticity and the

degree of dryness

[27]

B. breve Yakult Fermented milk,

galactooligosaccharides

101 healthy young female students

during 4 weeks

Skin health Increased hydration levels of the

stratum corneum

[28]

Bif. breve and L. mali Soymilk fermented Post-menopausal women during 8

weeks

Aging Delay skin aging [29]

L. casei Shirota Fermented soymilk 60 healthy premenopausal women

studied randomly through double-

blind, placebo-controlled trial as a

pilot study

Skin condition and gut microbiota - Increased levels of isoﬂavone

absorption

- Modiﬁed the gut microbiota in

premenopausal women

[30]

L. fermentum (ME‐3) Goat milk fermented Healthy male and female volunteers

with mild to moderate disease,

during 12 weeks, randomly

through double‐blind, placebo‐

controlled open comparative study

Atopic dermatitis Blood anti-oxidativity markers also

showed an improvement

[16]

S. Thermophilus, L. paracasei

LPC‐37, L. acidophilus 74‐2,

B.animalis ssp. Lactis DGCC420

Probiotic yogurt drink 15 Healthy people and 19 patients,

with atopic dermatitis, average

age: 23 ± 3 years, during 8 weeks

through placebo controlled and

cross‐over study

Atopic dermatitis Modulate immune parameters

No signiﬁcant eﬀect of probiotic on

patients

[31]

Probiotics and Antimicrobial Proteins

Table 3 The eﬀect of probiotics in fermented foods on skin cell lines

Strain Fermented food Model Mechanism of action Ref

L. helveticus NS8 Fermented milk supernatant Human HaCat keratinocyte cells and mouse

B16F10 melanoma cells

- Inhibitory eﬀects both to the enzymatic

activity of tyrosinase

- Expression of proteins required for melanin

synthesis

[38]

L. helveticus CM4 strain (LHMW) Fermented milk whey Mouse B16 melanoma cells with

melanocyte-stimulating hormone (MSH)

- Inhibition of the expression of the

tyrosinase gene family by lowering the

MITF expression level

[39]

L. plantarum TWK10 Black soy milk that is fermented and

germinated

Zebraﬁsh embryos - The ability of these ingredients to inhibit

melanogenesis suggests their potential for

use in whitening products

[40]

L. plantarum TWK10 Fermented soy milk Mouse B16F0 melanoma cells - Uracil, derived from aqueous extracts of

TWK10-fermented soy milk, had anti-

melanogenic eﬀects

[41]

L. plantarum TWK10 Fermented soy milk Mouse B16F10 melanoma cells - Inhibited mushroom tyrosinase and melanin

production

[42]

L. brevis BCRC12247 Fermented turmeric milk Human

ﬁbroblast cells

- Protecting ﬁbroblast cells from UVA-

induced photoaging and oxidative

[43]

L. plantarum, Saccharomyces cerevisiae Fermented ﬁsh oil Human HaCaT keratinocytes and mouse skin

tissue

- Protects the skin against UVB-induced

oxidative stress through antioxidant eﬀects

[44]

L. buchneri Plant extracts fermented with L. buchneri

(PELB)

CCD-986sk ﬁbroblasts and HaCaT

keratinocytes

In a study on UVB-induced photoaging,

it was found that PELB reduced elastase

activity and increased the expression of

type I collagen

[45]

S. thermophilus Fermented honeybush extracts (FH ex) and

scale-up fermented honeybush extracts

(SFH ex)

HaCaT human keratinocytes Anti-oxidative and -inﬂammatory eﬀects [46]

Consortium of microorganisms referred to as

kombucha

Kombucha-fermented blackberry extracts Human skin cells and yeast cell - Reduced oxidative stress in both human and

yeast cells

[47]

L. rhamnosus and Saccharomyces cerevisiae Fermented rice bran (FRBE) Mouse B16F10 melanoma cells

Human ﬁbroblast cells

- Reduced the melanin synthesis of the

resulting extract to B16F1 melanoma

- Protected ﬁbroblast cultures against

ultraviolet B (UV-B)-induced damage

invitro

[48]

L. plantarum JBMI F5 Fermented blackberry Human foreskin ﬁbroblast (Hs68) as well as

in SKH-1 hairless mice

UVB exposure causes wrinkle formation by

reducing dermal matrix density, but anti-

photoaging measures can prevent this

[49]

Probiotics and Antimicrobial Proteins

acne vulgaris and the metabolic processes of the intestinal

tract. Another study revealed that taking an oral supplement

containing L. acidophilus and Bif. bifidum, in addition to

improving clinical outcomes, increased patient tolerance and

compliance with antibiotics. Furthermore, oral supplementa-

tion of L. rhamnosus SP1 (LSP1) improved the appearance

of acne patients [63]. Consumption of the commercial sup-

plement L-Bios (a combination of B. probiotics with rice

starch and maltodextrin) also acted as a stimulus to increase

IL-10 serum levels. A combination supplement of probiotics

L. acidophilus, Bif. bifidum, and L. delbrueckii was observed

to reduce the side effects of minocycline administration (an

antibiotic used to treat acne vulgaris). These results indicate

that probiotic mixtures have the potential to be an alternative

treatment option for acne vulgaris. Based on this evidence,

it appears that oral probiotics can be effective as adjunctive

care in the treatment of acne vulgaris. More investigation

into the use of probiotics in individuals with acne is neces-

sary to support these early findings [85].

Various attempts have been made to utilize probiotics to

treat psoriasis, which is an inflammatory disease. Studies

have shown that consuming fermented milk with L. casei as

an oral supplement can help regulate and modulate immune

responses [73]. Another study found that a probiotic sup-

plement containing Bif. infantis 35264 was associated with

a decrease in plasma levels of inflammatory cytokines and

reactive protein [67], leading to improvement in the condi-

tion. In addition, daily consumption of a supplement con-

taining a mix of three probiotics for 12 weeks resulted in

a significant reduction of psoriasis lesions and decreased

dependency on steroids [75]. A supplement containing L.

pentosus GMNL-77 bacteria was also found to have positive

effects in reducing the level of atopic dermatitis lesions in

mice P302. Although there is limited evidence on probi-

otic prophylaxis for psoriasis (Table5), a recent study on

a 47-year-old female patient who was unresponsive to all

other therapeutic drugs found that L. sporogenes probiotic

supplementation stood out and provided hope [74]. More

evaluations are necessary to develop new treatment strate-

gies. When we reviewed the studies on the impact of probiot-

ics on wound healing, we found that there were only a few

studies that explored the connection between probiotic thera-

pies and wound healing. However, the studies that did exist

mostly reported a minor positive impact of probiotics on

wound healing [81]. Nevertheless, more conclusive research

is required to investigate the effects of probiotics on wound

Table 4 Functionality of probiotic strains on skin cells

MRS De Man–Rogosa–Sharpe agar, HDF human dermal ﬁbroblasts, B16-F10 a cell line exhibiting a morphology of spindle-shaped and epithe-

lial-like cells that was isolated from skin tissue of a mouse with melanoma

Microorganisms Media Culture condition Cells Mechanism action Ref

Bif. bifdum strain (BCRC

11844)

MRS 1% (v/v) transferred to a

50-mL culture medium

incubated in 37°C for 48h

B16F10 Decreasing the melanin

Inhibition of tyrosinase

[8]

Bif. adolescentis strain (BCRC

14658)

MRS 1% (v/v) transferred to a

50-mL culture medium

incubated in 37°C for 48h

B16F10 Suppressing tyrosinase activity

Decreasing the melanin

[58]

L. rhamnosus LRH113 MRS 1% in 400-mL culture medium

incubated in 37°C for 20h

ND Suppressing tyrosinase activity

Promoting moisture retention

[55]

L. gasseri BRN17 (Accession

No: KCTC10902 BP)

MRS Inoculum was incubated in

37°C for 16 h

B16-F10 murine melanoma

cells and HaCaT human

keratinocytes

Anti-melanogenic reducing

tyrosinase activity

Downregulating α-MSH-

induced melanogenesis-

related gene expression

[59]

Bif. infantis strain (BCRC

14602)

MRS 1% (v/v) of inoculum was

transferred to a 50-mL

culture medium in 37°C for

48h

B16F1 Suppressing murine B16F10

tyrosinase activity and the

amount of melanin

[60]

The autolysate of Leuconostoc

mesenteroides MRS 1% (v/v) of inoculum was

transferred to culture medium

in 30°C for 24h

B16F1 No inhibition of tyrosinase

Decreasing melanin content in

B16F0 cells and human skin

model

[57]

Bif. lactis

Bif. longum

L. casei

L. plantarum

L. reuteri

L. rhamnosus

MRS Inoculum was incubated in

37°C for 24h

Normal HDF Inhibiting tyrosinase activity

and alpha-melanocyte-

stimulating hormone-induced

melanin production in human

epidermal melanocytes

[61]

Probiotics and Antimicrobial Proteins

Table 5 The eﬀects of probiotic supplements on skin health

Probiotic type Dose Statistical population and duration

of study

Skin disorders Mechanism action Ref

L. rhamnosus SP1 Liquid, once daily 3 × 109 cfu/day

(75mg/day)

20 adults with acne during 12-week

studied randomly through double-

blinded, placebo-controlled study

Acne vulgaris Improve skin appearance [63]

L. acidophilus, L. delbrueckii sub

bulgaricus, Bif. biftdum 5 and 20 billion CFU/capsule 45 females studied randomly during

12 weeks

Acne vulgaris Improvement of acne symptoms [64]

Bif. lactis W51, B. lactis W52, L.

acidophilus W55, L. casei W56, L.

salivarius W57, L. lactis W58, rice

starch, malodextrin

Mix 2 sachets with 500 cm3 of water

and take daily before breakfast

Total bacterial cells > 108 CFU

33 subjects with acne vulgaris

For a period of 30 days, a pre-

experimental clinical study was

conducted using a pretest-post-test

design

Acne Vulgaris Acne vulgaris is associated with

high levels of interleukin-10 in the

bloodstream

[65]

L. plantarum CJLP55 Daily one bag/1.0 × 1010 CFU 15 patients with acne vulgaris were

included in the study, consisting of

7 males and 8 females

Placebo supplements for 12 weeks

in this double-blind, placebo-

controlled randomized study

Acne Vulgaris Improved acne lesion count

and grade, decreased sebum

triglycerides (TG)

- Increased hydration and ceramide

[66]

L. GG 1 × 1010 CFU daily for 2–4 weeks

before expected delivery

After delivery, breast feeding

mothers could take the capsules

until 6 months

Mothers with atopic eczema, allergic

rhinitis, or asthma, and post-natally

for 6 months to their infants;

132 2-year-old children studied

randomly through a double-blind,

placebo-controlled trial during 2–4

weeks,

Atopic dermatitis This is eﬀective in preventing early

onset of atopic diseases in children

who are at a higher risk

[66]

L. plantarum CJLP133 Two daily doses of L. plantarum

5 × 109 UFC

Children who were between one and

12 years old were studied during 12

weeks through randomized trial

Atopic dermatitis Reduction in eosinophil counts and

levels of IFN-gamma and IL-4 at

the end of treatment

[67]

L. plantarum IS-10506 Twice daily 1010 CFU/day) 22 patient children were studied

randomly through double-blind,

placebo-controlled trial

Atopic dermatitis Th2 adaptive immune response

suppression has been observed to

result in clinical improvement in

certain cases

[68]

L. rhamnosus 19070–2 and L. reuteri

DSM 12246 1010 CFU 41 patient children were studied for

6 weeks through double-blinded,

placebo-controlled, cross-over

study

Atopic dermatitis Improvement of severity of eczema [69]

L. paracasei GMNL133(LP), L.

fermentum GM090 (LF), & the

LP + LF mixture

LF (2 × 109 (CFU), an LP and LF

mixture (4 × 109 CFU)

210 children aged 1–18 years with

moderate-to-severe AD were

studied for 12 weeks through

double-blind, prospective,

randomized placebo-controlled

study

Atopic dermatitis Combination of probiotic LP and LF

may be eﬀective in reducing the

severity of AD and improving the

quality of life of aﬀected children

[70]

Probiotics and Antimicrobial Proteins

Table 5 (continued)

Probiotic type Dose Statistical population and duration

of study

Skin disorders Mechanism action Ref

Bif. animalis Capsule containing 6 × 109 CFU/

capsule

44 male and female adults with

moderate or severe AD were

studied randomly for 8 weeks

through double‐blind, placebo‐

controlled, parallel‐group

comparative study

Atopic dermatitis - Improvement in severity scores of

Improvement in itch and QoL scores

[26]

Bif. breve Each capsule contains 2.0 × 1010

CFU, and the recommended dosage

is two capsules per day for the

subjects

There were 24 adult patients

diagnosed with AD

A randomized, double-blind,

placebo-controlled study was

conducted over a period of 8 weeks

Atopic dermatitis Severity scoring for atopic dermatitis

signiﬁcantly improved

[71]

L. salivarius LS01 + tara gum 1 × 109 CFU/sachet, twice daily 38 males and females, with

moderate/severe AD, age 18–46

years 16 weeks, randomized,

double‐blind, placebo‐controlled

study

Atopic dermatitis Shortening the time required for the

onset of the positive eﬀects

[72]

L. salivarius LS01DSM 22775 and

S. thermophiles ST10 DSM

5 × 109 CFU/sachet of L. salivarius

2 × 109 CFU/sachet of S.

thermophilus

25 males and females with AD,

age 25–63 years were studied

for 30 days through prospective,

controlled pilot trial

Atopic dermatitis Improvement in SCORAD index [72]

B. infantis 35624 Daily dose, 10 × 109 CFU 26 patients male and female were

studied for 8 weeks

Psoriasis Decrease in plasma levels of TNF-a

and C-reactive protein

[67]

L. casei DN-114 001 Daily by oral gavage with 200

Actimel, 108 cfu/mL

C57BL6 female (5–6-week-old) mice

were studied during 12 weeks

Psoriasis Decrease skin inﬂammation [73]

L. sporogenes One sachet three times daily with

biotin 10 mg once daily

47-year-old woman with pustular

psoriasis was studied for 6 months

Psoriasis Descend in fever ameliorating

lesions

[74]

Bid. longum CECT 7347, B. lactis

CECT 8145, and L. rhamnosus

CECT 8361

Daily a gelatin capsule containing

probiotic strains in 1:1:1 ratio, with

maltodextrin with a total of 1 × 109

90-year-old adults with plaque

psoriasis were studied randomly

for 2 weeks, through double-blind,

placebo-controlled trial

Psoriasis Reduced of psoriasis severity a lower

risk of relapse after the intake of

the probiotic

[75]

L. pentosus GMNL-77 Doses of GMNL-77 (5 × 107

CFU/0.2 mL/day or 5 × 108

CFU/0.2 mL/day) or with the

vehicle control (distilled water)

Imiquimod-treated mice male

BALB/c mice were studied (6–8

weeks; 20–25 g) for 7 consecutive

days

Psoriasis Decreased erythematous lesions and

epidermal thickening

[76]

Bif. breve BR03, L. salivarius LS01 Doxycycline 40 mg once a day and

probiotic twice a day 1 × 109 UFC/

dose)

37-year-old man was studied for 8

weeks

Rosacea Improvement in skin and eye

symptoms

[77]

L. plantarum HY7714 1 × 1010 CFU/day of HY7714 110 volunteers aged 41 and 59 years

old with dry skin and wrinkles

were studied randomly for 12

weeks, through double blind,

placebo-controlled study

Skin aging

Rejuvenation

- Improved the skin elasticity

- Reduction in wrinkle depth

[78]

Probiotics and Antimicrobial Proteins

Table 5 (continued)

Probiotic type Dose Statistical population and duration

of study

Skin disorders Mechanism action Ref

L. johnsonii (La1) + carotenoids Daily dose of 5 × 108 and 7.2 mg

carotenoids

139 people were studied during 10

weeks

Skin aging

Reduced induced skin damage

Inﬂuence on the long‐term eﬀects of

UV exposure and more speciﬁcally

on skin photoageing

[79]

S. thermophilus TCI633 isolated

from human breast milk

The ingredients of the TCI633

capsules were 5 × 108 live S.

thermophiles, maltodextrin, silicon

dioxide, and magnesium stearate

were dissolved in H2O

Hs68 cell-line were topically treated

by S. thermophilus TCI633 isolated

from human breast milk

Skin aging Improving the serum biochemical

HA, SOD and catalase levels and

anti-skin age markers

[64]

L. casei 431 1.5 × 109 CFU once a day 74 primiparous women one day after

giving birth were studied for 14

days

Wound healing Eﬀective in healing episiotomy

wounds

[80]

L. acidophilus, L. casei, L.

fermentum, B. biﬁdum 2 × 109 CFU/g each strain, a daily 60 people (aged 40–85 years old)

with grade 3 (diabetic foot ulcers

(DFU) were studied for 12 weeks,

randomized, double-blind, placebo-

controlled trial

Diabetic wound healing Eﬀects on the DFU size

Decreased the serum total

cholesterol and CRP and increased

plasma nitric oxide (NO) and total

plasma antioxidant capacity

[81]

L. fermentum

L. delbluruekii Twice daily/sachets containing

powder with 10 billion CFU

40 thermally-injured patients

with burns between 20 and 50%

and depths between 5 and 10%

were studied randomly through

a prospective, double-blind,

controlled clinical trial

Burn

Wound healing

Improvement in the patients’

overall outcome related to wound

healing and length of hospital stay

following the use of probiotics

[82]

VSL#3 (Ferring Pharmaceutical,

Italy)

Probiotic mixture containing eight

strains of probiotic bacteria

2 × 108 colony forming units (CFU)

(high dose) or 2 × 107 CFU (low

dose) of VSL#3 in 200 μL saline

solution

C57BL/6 mice were studied during

18 days

Cancer - Increase in propionate and butyrate

levels promoted the expression of

chemokine

- Decreased the number of tumor

foci in lungs and attenuated the

lung metastasis of melanoma cells

[83]

Probiotics and Antimicrobial Proteins

healing. For instance, some research have indicated that pro-

biotic supplements have a beneficial effect on patients with

diabetic foot ulcers [86]. While the study showed promise,

its generalizability is limited due to the small sample size.

Additionally, information on wound healing, quality of life,

side effects, and amputation rates was not reported. Wound

dressings embedded with probiotics are now prime candi-

dates for designing wound healing therapeutic approaches

to combat infections and promote the healing process [87].

The recent reports state that it is not possible to make a

clear and accurate conclusion about the effectiveness of

probiotics on wound healing, based on the findings of other

researchers. While none of the studies reported adverse

effects, this area shows promise for future research. Therefore,

additional studies are necessary to identify the dimensions and

mechanism of the effect of probiotics on wound healing [88].

A study has shown that probiotic supplementation can

inhibit the spread of lung melanoma cells. The study used

a commercial probiotic supplement called VSL#3, which

contains eight bacterial strains. The supplement increased

the levels of propionate and butyrate in the body, as well as

the expression of inflammatory chemokines [83]. Overall,

this resulted in a reduction in the metastasis of mouse lung

melanoma cells.

A study examining the effect of probiotic supplementa-

tion on patients with rosacea found that those who received

both Escherichia coli Nissle 1917 as an oral probiotic and

standard topical treatment had a better outcome than those

who only received local treatment. This was particularly

noticeable in patients with papulopustular exanthema, which

affected 36% of those with rosacea. Furthermore, a combina-

tion of Bif. breve BR03 and salivarius LS01 probiotics with

low-dose doxycycline (40 mg/day) for 8 weeks were also

found to improve the skin [77].

Based on Table5, the research on the impact of probiot-

ics on skin disorders such as psoriasis, cancer, wounds, and

rosacea is limited. However, there have been more studies

conducted on atopic dermatitis, which may be attributed

to its higher prevalence compared to other skin condi-

tions. Nevertheless, the clinical trials conducted so far have

reported positive results in the improvement of atopic der-

matitis symptoms after taking probiotics. However, some

studies suggest that certain probiotics do not have any effect

on the treatment of this disease. Therefore, due to some

ambiguities and contradictory results, the role of probiotics

in the treatment of acne vulgaris has not been definitively

determined.

Based on the currently available evidence and reports, it

is difficult to make a definitive recommendation regarding

the use of probiotics to prevent atopic dermatitis. Therefore,

further studies are needed to investigate the potential effects

of probiotics on patients [89].

Today, many people are interested in taking food sup-

plements to protect and improve their skin. In this context,

the positive effect of fermented soybean milk supplement

containing L. casei Shirota on improving skin conditions

such as elasticity, dryness, pigmentation, roughness, and

moisture in the skin of healthy women has been reported

[90]. Also, probiotic oral supplements have recently been

suggested to protect the skin against damage caused by ultra-

violet rays. In this regard, taking a supplement containing

probiotic L. johnsonii plus carotenoids in healthy women

led to a decrease in the density of Langerhans cells caused

by ultraviolet radiation and accelerated recovery of immune

system homeostasis [91]. In addition, the role of oral supple-

ments in skin protection, and their use in skin improvement

has also been reported [78]. In this regard, the effect of Bif.

breve B-3 on chronic UV-induced skin aging in hairless mice

showed that this strain significantly inhibited transdermal

water loss, skin hydration, and epidermal thickening [92].

In a preclinical study against photoaging in hairless mice

after treatment with L. plantarum HY7714, wrinkles were

reduced in number, depth, and surface [78]. This significant

reduction could confirm the effectiveness of probiotics in

skin aging. Therefore, the researchers’ findings show that

oral administration of probiotics has the potential to prevent

UV-induced skin damage and supports the hypothesis that

probiotics are beneficial not only for the gut but also for the

skin.

It is believed that the oral consumption of probiotics, in

addition to improving skin health, can also help improve

mental and nervous health [93]. Interestingly, the intesti-

nal microbiota can communicate with the hypothalamus

and pituitary gland through neurological and immuno-

logical signals, constituting the microbiome-gut-brain

axis. This bidirectional communication pathway enables

the gut to affect the skin and vice versa [94]. Expanding

on the gut-brain connection, the gut-associated lymphoid

tissue (GALT) interacts with the intestinal microbiota,

influencing immune responses and impacting brain

function directly or indirectly. Research has correlated

disturbances in the gut-brain axis with a range of health

concerns, including stress reactions, mood disorders like

anxiety and depression, alterations in cognitive function

such as memory decline, as well as various conditions

such as digestive, metabolic, and neurological disorders

[95]. In a review study in 2023, the role of probiotics in

modulating the gut-brain axis has been discussed, the sup-

portive impacts of probiotics on central nervous systems,

and the decrease or control of the incidence of some men-

tal disorders [96]. In addition, it reported the consumption

of fermented foods has been linked to positive mental

health. Modifications in the gut microbiota can impact

mood and fatigue, offering therapeutic benefits [10]. As

Probiotics and Antimicrobial Proteins

a result, probiotics offer promise as supportive or adjunc-

tive therapies for a range of mental health issues.

The Role ofNon‑edible orTopical Probiotics

inSkin Care

There is a growing interest in the use of live bacteria for

the management of inflammatory and infectious diseases,

particularly those affecting the skin. The application of

live probiotics has emerged as a targeted treatment strat-

egy for addressing these disorders and enhancing skin

health. This approach involves the introduction of live

bacteria to balance the skin’s microbiota and immune

homeostasis. The ultimate goal is to promote skin regen-

eration through the use of active ingredients. Research-

ers are particularly focusing on the use of live probiotics

for the treatment of skin diseases. Table6 presents some

studies on the effect of live probiotics on the care and

treatment of skin disorders.

The Probiotic Mechanism ofAction inSkin Care

In the review of studies, it was observed that probiotics

act based on specific mechanisms. The reviewed studies

demonstrate that the most promising probable mechanism

for oral probiotics to benefit the skin is by being absorbed

via the digestive system and affecting the immune system.

This absorption leads to reduced inflammation, which in

turn promotes skin health. The main mechanisms include

strengthening the skin barrier and immune system, regulat-

ing and modulating inflammatory factors, preventing aging,

and facilitating wound healing. Additionally, probiotics are

effective in protecting the skin against aging, oxidative

stress, and light damage [99].

Many probiotics have been effective in preventing UV-

induced skin damage. Melanin is a key factor in determining

skin color and helps to protect against the harmful effects of

UV radiation. Skin diseases can occur when melanin pro-

duction is abnormal, which is why regulating melanogenesis

is an important strategy for treating abnormal skin pigmenta-

tion. In melanocytes, melanogenesis is the process of mela-

nin synthesis, which is controlled by several enzymatic and

chemical reactions. One of the enzymes responsible for reg-

ulating melanogenesis is tyrosinase, which can be activated

by probiotic bacteria. Probiotics are particularly important

because they produce metabolites during the fermentation

process that can suppress melanogenesis [50, 99].

Recent scientific research suggests that probiotics

can be an effective treatment for skin aging [100]. There

are various theories to explain aging mechanisms, with

the oxygen free radical theory being widely accepted.

Reactive oxygen species (ROS) can attack biological

molecules and lead to several age-related diseases. Anti-

oxidant capacity is crucial in slowing down the aging

process [101]. Probiotics have been found to possess

antioxidant activity and have been studied extensively.

Table 6 The eﬀect of some non-edible (topical) probiotics on the skin

C57BL/6, often referred to as “C57 black 6,” “B6,” “C57”, or “black 6,” is a common inbred strain of laboratory mouse. BALB/c is an albino,

laboratory-bred strain of the house mouse from which a number of common sub-strains are derived. Hs68 is a ﬁbroblast cell that was isolated

from the foreskin of an aspartoacylase deﬁciency White male patient

Microorganism Culture media Probiotic-treated cell line and

skin samples

Skin condition

(normal/disorder)

Mechanism of action Ref

L. reuteri DSM 17938 (BioGaia

AB)

MRS,

triglycerides,

sunﬂower oil

Reconstructed human epidermis Normal Anti-inﬂamation, anti-

microbial activity against skin

pathogens. Decreased the

inﬂammatory process

[65]

Bif. animalis ssp. lactis Bb12

CHR Hansen Bb 12

MRS Keratin from human epidermis Atopic dermatitis Preventing pathogen adhesion [78]

Bif. lactis B-94 DELVO PRO

LAFTI B-94

MRS Keratin from human epidermis Atopic dermatitis Preventing pathogen adhesion [78]

L. rhamnosus DSM 20021 MRS Human keratinocyte line

HaCaT

Skin dysbiosis Preventing pathogen adhesion

Wound healing, through support

therapy in infections lead by

S. aureus

[59]

L. rhamnosus GG, L. plantarum

WCFS1, and L. pentosus

KCA1

MRS Nijerian facial skin samples and

vagina

Acne vulgaris Anti-inﬂammatory,

antimicrobial, anti acne, anti-

malodor for axillary part

[97]

L. plantarum (SkinDuoTM)

Anti-acne serum with L.

plantarum

MRS (SkinDuoTM)

the skin models

Acne vulgaris Decrease in lipid synthesis, and

markers of inﬂammation

[98]

Probiotics and Antimicrobial Proteins

While the exact mechanisms of their activity are not

fully understood, it is believed that lactic acid bacteria

can play an antioxidant role by inhibiting ROS, chelating

metals, increasing the level of antioxidant enzymes, and

modulating microbiota [102]. Therefore, oral and topical

probiotics can be a promising intervention for skin aging.

Probiotic bacteria can be beneficial in reducing inflam-

mation in autoimmune skin conditions. Researchers have

found that taking a probiotic supplement can improve skin

quality by regulating the immune system and reducing or

modulating the production of regulatory cytokines and

growth factors. This can improve the production process

of the stratum corneum, leading to better skin barrier

function and reduced dryness. Additionally, probiotic

bacteria have anti-inflammatory and anti-bacterial prop-

erties that can reduce photoaging and offer protection

against UVR-B-mediated inflammatory pathways [16].

Probiotics applied topically have been shown to reduce

the concentration of pathogenic pathogens on the skin due

to their anti-microbial properties [103].

It has been observed that topical probiotics can enhance

the synthesis of ceramides, display anti-inflammatory

effects, and promote the binding of various probiotic strains

to human skin. These benefits may help reinforce the skin

barrier and possibly prevent pathogenic attacks, thanks to

the production of anti-microbial amino peptides by probiot-

ics. This finding highlights the potential of topical probiot-

ics as a promising strategy for skin health and protection

[97]. Probiotics can also act as anti-adhesive agents against

other bacterial species, preventing the arrival of pathogens.

Beneficial bacteria are naturally derived from the body’s

flora and can reduce harmful microorganisms through

various mechanisms, including displacement of patho-

gens. Probiotic agents have multiple mechanisms to fight

against pathogens. They can outcompete the pathogen for

nutrients necessary for their growth, or limit the binding

of other bacteria. Additionally, they can enhance the bar-

rier function of the intestine by increasing the production

of intestinal mucin. Despite the numerous mechanisms, it

is still difficult to fully understand the precise functioning

of probiotics, and more studies and discussions are needed

[104].

Current Challenges andFuture Opportunities

Controlling and improving skin diseases through the mod-

ulation of skin microbiota is a widely accepted strategy.

However, only a few probiotics are currently being used for

this purpose [105]. The appropriate dosage of probiotics for

achieving the desired effect remains unknown, making it

an important challenge. Additionally, the full response of

skin microbiomes to probiotics is not yet fully understood

[106]. To address this, omics technologies can be employed

to provide insights into the interactions between skin micro-

biota and skin diseases. These technologies can also help

identify microbial markers for the diagnosis and treatment

of skin diseases [105].

The survival of probiotic bacteria in skin care products

is a major challenge for the industry. To address this issue,

the encapsulation process is often used in therapeutic prod-

ucts. Encapsulation helps keep probiotics alive throughout

the digestive tract, but it comes with its own set of chal-

lenges. These include selecting non-toxic materials, develop-

ing micro-coating methods, choosing protective materials,

determining capsule size, managing different particle sizes,

and selecting appropriate emulsifiers [107].

In the case of topical probiotics, dead bacteria, bacterial

extracts, or metabolites are often used to address the issue

of probiotic survival. Heat-inactivated probiotics can also

play a role in managing skin or allergic respiratory diseases

[108]. The impact of probiotics on health and skin disorders

depends on the duration and number of studies conducted

[89]. It is crucial to establish the efficacy of probiotics and

their components, given their constant exposure to clothing

and other environmental factors. As a result, one of the key

challenges is to ensure that probiotic strains are effective in

maintaining skin health [8].

The production of skin care products faces an important

challenge — lack of transparency in the information provided

about the products. The information available is often vague

and does not offer insights into the product features [109].

For example, several questions remain which will ulti-

mately benefit the skin to a greater extent: oral ingestion

or topical application? Also, will a combination approach

of oral and topical prove to be the most effective [110]? To

address this issue, it is essential to clearly state information

about the species, bacterial strain, metabolite type, and time

of use [105]. These details are crucial as the type of strain,

skin disease, and the time of probiotic administration can

affect skin function. The importance of providing accurate

information is even greater for immunocompromised or

high-risk patients as probiotics have been known to cause

or worsen fungal infections, especially in such individuals.

The lack of scientific evidence and clinical studies, espe-

cially clinical trials, is a significant challenge in evaluat-

ing the effectiveness of probiotics. Conflicting reports on

the effectiveness of probiotics highlight the need for more

information. For instance, the application of probiotics for

the treatment of various skin conditions like eczema, acne,

and cutaneous candidiasis necessitates further investigation

due to the lack of sufficient evidence and the presence of

conflicting findings in existing studies. Moreover, despite

the importance of animal models, their results cannot be

universally applied to humans [89].

The use of probiotics for treating infectious diseases is

not supported by the limited results of meta-analyses. This

Probiotics and Antimicrobial Proteins

is mainly due to the limited number of studies conducted,

lack of standardization in the studies, and inconsistency

in the results [111]. It is vital to examine the impacts of

oral and topical probiotics on skin conditions, along with

their potential adverse effects, including allergic responses,

bacteremia, and the transfer of antibiotic resistance among

pathogens [111].

The lack of adequate information and strong regulatory

frameworks expressing production requirements pose a

significant challenge in assessing the quality of products

[32]. Regulatory standards can indeed facilitate the crea-

tion of new products and safeguard consumers. In the realm

of probiotics used in skin care products, while the initial

results are encouraging, additional research is needed to

confirm their safety, efficacy, and mode of action [4]. Thus,

new approaches should be developed to improve probiotic

research for future studies. Additionally, after identifying

safe probiotics, further studies should be conducted to deter-

mine dosages, side effects, safety, and regulations.

Conclusion

This study investigated the effects of probiotics on skin

care. Studies showed that probiotics on fermented foods

or pure supplements can benefit skin health and diseases.

More clinical studies are needed on how fermented foods

and probiotic-supplemented products work on skin care.

However, there are limitations and safety concerns associ-

ated with using probiotics in skin care products. Since pro-

biotic safety has not been established for all age groups and

high-risk individuals, their potential use should be carefully

evaluated. In addition, despite challenges in preserving the

viability and activity of live bacteria when applied topically

on the skin, topical probiotics can impact skin care. Fur-

thermore, the current research has limitations, including the

need for larger, well-designed clinical trials to confirm these

findings. To ensure transparency and accuracy, legal require-

ments for clear labeling and information provision in skin

care products are necessary for consumers and researchers.

Future investigations could focus on safe probiotic strains,

dosages of probiotics, probiotic products, probiotic metabo-

lites, and delivery methods to optimize their efficacy for

different skin conditions.

Author Contributions F. SH: Conceptualization, Investigation, writ-

ing—original draft preparation. F. S: investigation, editing of draft.

S.M: project administration, review and editing. M. Z: supervision

and review of paper.

Data Availability No datasets were generated or analysed during the

current study.

Declarations

Ethics Approval Not applicable.

Consent to Participate Not applicable.

Consent for Publication All the authors consented to the publication.

Competing Interests The authors declare no competing interests.

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May 2024

To ensure effective administration of probiotics in clinical practice, it is crucial to comprehend the specific strains and their association with human health. Therefore, we conducted a systematic review and meta-analysis to evaluate the scientific evidence on the impact of Lactiplantibacillus plantarum probiotic consumption on human health. Out of 11,831 records, 135 studies were assessed qualitatively, and 18 studies were included in the meta-analysis. This systematic review demonstrated that probiotic supplementation with L. plantarum, either alone or in combination, can significantly improve outcomes for patients with specific medical conditions. Meta-analysis revealed notable benefits in periodontal health, evidenced by reduced pocket depth and bleeding on probing (p < 0.001); in gastroenterological health, marked by significant reductions in abdominal pain (p < 0.001); and in infectious disease, through a reduction in C-reactive protein levels (p < 0.001). Cardiovascular benefits included lowered total cholesterol and low-density lipoprotein cholesterol in the L. plantarum intervention group (p < 0.05). Our study’s clinical significance highlights the importance of considering probiotic strain and their application to specific diseases when planning future studies and clinical interventions, emphasizing the need for further research in this area.

Probiotics in Wound Healing

Article

Full-text available

May 2024
INT J MOL SCI

Wound infections caused by opportunistic bacteria promote persistent infection and represent the main cause of delayed healing. Probiotics are acknowledged for their beneficial effects on the human body and could be utilized in the management of various diseases. They also possess the capacity to accelerate wound healing, due to their remarkable anti-pathogenic, antibiofilm, and immunomodulatory effects. Oral and topical probiotic formulations have shown promising openings in the field of dermatology, and there are various in vitro and in vivo models focusing on their healing mechanisms. Wound dressings embedded with prebiotics and probiotics are now prime candidates for designing wound healing therapeutic approaches to combat infections and to promote the healing process. The aim of this review is to conduct an extensive scientific literature review regarding the efficacy of oral and topical probiotics in wound management, as well as the potential of wound dressing embedding pre- and probiotics in stimulating the wound healing process.

Unveiling the therapeutic symphony of probiotics, prebiotics, and postbiotics in gut-immune harmony

Article

Full-text available

Feb 2024

The gut microbiota and immune system interaction play a crucial role in maintaining overall health. Probiotics, prebiotics, and postbiotics have emerged as promising therapeutic approaches to positively influence this complex axis and enhance health outcomes. Probiotics, as live bacteria, promote the growth of immune cells, shape immune responses, and maintain gut barrier integrity. They modify the gut microbiota by fostering beneficial bacteria while suppressing harmful ones. Additionally, probiotics interact with the immune system, increasing immune cell activity and anti-inflammatory cytokine production. Prebiotics, as indigestible fibers, selectively nourish beneficial microorganisms in the gut, enhancing gut microbial diversity and activity. This, in turn, improves gut health and boosts immune responses while controlling inflammation through its immunomodulatory properties. Postbiotics, produced during probiotic fermentation, such as short-chain fatty acids and antimicrobial peptides, positively impact gut health and modulate immune responses. Ensuring quality control and standardization will be essential for successful clinical implementation of these interventions. Overall, understanding and harnessing the gut microbiota-immune system interplay offer promising avenues for improving digestive and immunological health.

Human Skin Aging and the Anti-Aging Properties of Retinol

Article

Full-text available

Nov 2023

Taihao Quan

The skin is the most-extensive and -abundant tissue in the human body. Like many organs, as we age, human skin experiences gradual atrophy in both the epidermis and dermis. This can be primarily attributed to the diminishing population of epidermal stem cells and the reduction in collagen, which is the primary structural protein in the human body. The alterations occurring in the epidermis and dermis due to the aging process result in disruptions to the structure and functionality of the skin. This creates a microenvironment conducive to age-related skin conditions such as a compromised skin barrier, slowed wound healing, and the onset of skin cancer. This review emphasizes the recent molecular discoveries related to skin aging and evaluates preventive approaches, such as the use of topical retinoids. Topical retinoids have demonstrated promise in enhancing skin texture, diminishing fine lines, and augmenting the thickness of both the epidermal and dermal layers.

The Role of Probiotics in Skin Health and Related Gut-Skin Axis: A Review

Article

Full-text available

Jul 2023

Aging skin, wrinkles, pigmentation, and dryness are problems that plague people, and researchers are working to solve them. Recent studies have shown that intestinal microbiota homeostasis can influence skin health, demonstrating the existence of a gut-skin axis. Recently, improving skin health through probiotic interventions has been proposed, and micro-ecological skin care is becoming a popular concept. By regulating skin health and gut-skin axis interactions, probiotics can be used as potential management tools to suppress and improve skin diseases in multiple ways, including decreasing oxidative stress, suppressing inflammatory responses, and keeping immune effects. The purpose of this paper is to provide a comprehensive review of the application and mechanisms of probiotic-mediated gut microbiota homeostasis in skin care and to offer a theoretical basis for the application of probiotics in skin care.

Oral and Topical Probiotics and Postbiotics in Skincare and Dermatological Therapy: A Concise Review

Article

Full-text available

May 2023

The skin microbiota is a pivotal contributor to the maintenance of skin homeostasis by protecting it from harmful pathogens and regulating the immune system. An imbalance in the skin microbiota can lead to pathological conditions such as eczema, psoriasis, and acne. The balance of the skin microbiota components can be disrupted by different elements and dynamics such as changes in pH levels, exposure to environmental toxins, and the use of certain skincare products. Some research suggests that certain probiotic strains and their metabolites (postbiotics) may provide benefits such as improving the skin barrier function, reducing inflammation, and improving the appearance of acne-prone or eczema-prone skin. Consequently, in recent years probiotics and postbiotics have become a popular ingredient in skincare products. Moreover, it was demonstrated that skin health can be influenced by the skin–gut axis, and imbalances in the gut microbiome caused by poor diet, stress, or the use of antibiotics can lead to skin conditions. In this way, products that improve gut microbiota balance have been gaining attention from cosmetic and pharmaceutical companies. The present review will focus on the crosstalk between the SM and the host, and its effects on health and diseases.

Acne Vulgaris Topical Therapies: Application of Probiotics as a New Prevention Strategy

Article

Full-text available

May 2023

The skin microbiome is an essential barrier for preventing the invasion of pathogens and regulating the immune responses. When this barrier is disrupted, several dermatoses, including acne vulgaris, may arise. Most people will experience acne starting at the onset of puberty and continuing into adolescence; a significant percentage of those individuals continue to suffer from it into adulthood. Although common, this dermatosis usually has an enormous impact on the self-esteem and quality of life of individuals who suffer from it. An increase in consumer literacy regarding skincare leads buyers to seek out innovative products containing ingredients with proven benefits for their concerns. Probiotics have proven to be an alternative to the use of antibiotics, often associated with undesirable effects, in the treatment and prevention of dermatological disorders such as acne. This review provides a comprehensive analysis of the pathophysiology, risk factors, symptoms, conventional treatment recommendations and main studies emphasizing innovative topical products for acne-prone skin based on probiotics. In addition, the potential advantages, and limitations/challenges associated with the implementation and manufacturing of these innovative skin products are also highlighted.

The effect of probiotic supplementation on episiotomy wound healing among primiparous women: a triple-blind randomized clinical trial

Article

Full-text available

May 2023

Background Probiotics increase the defense power of immune system and accelerate the wound healing process by anti-inflammatory mechanisms at the wound site. The present study aimed at evaluating the effect of Lactobacillus casei oral supplementation on episiotomy wound healing among primiparous women. Methods This triple-blind randomized clinical trial was performed on 74 primiparous women delivered in Alzahra Hospital, Tabriz, Iran. Participants with mediolateral episiotomy (incision length equal to and less than 5 cm) were randomly assigned to the probiotic and placebo groups. The probiotic group received Lactobacillus casei 431 with 1.5 * 10⁹ colony-forming unit /capsule once a day from the day after birth to 14 days. Wound healing as a primary outcome was measured by Redness, Edema, Ecchymosis, Discharge, Approximation and pain as a secondary outcome by the Visual Analogue Scale before discharge, 5 ± 1 and 15 ± 1 days after birth. The data were analyzed using independent t-test and repeated measures one way analysis of variance. Results The mean (standard deviation: SD) score of wound healing in the probiotic group altered from 4.91(1.86) before discharge to 1.55 (0.99) during 5 ± 1 days after birth and reached to 0.95 (0.27) during 15 ± 1 days after birth. Further, the mean (SD) score of wound healing in the placebo group altered from 4.62 (1.99) before discharge to 2.80 (1.20) during 5 ± 1 days after birth and reached to 1.45(0.71) during 15 ± 1 days after birth (adjusted mean difference: -0.50, confidence interval 95%: -0.96 to -0.05, P = 0.03). Conclusion Lactobacillus casei oral supplementation is effective in healing episiotomy wounds. It is suggested to evaluate the effect of topical use of Lactobacillus casei on episiotomy repair and pain in further studies. Trial registration Iranian Registry of Clinical Trials (IRCT): IRCT20170506033834N7. Date of registration: 11/08/2021.

The Role of Probiotics and Their Metabolites in the Treatment of Depression

Article

Full-text available

Apr 2023
MOLECULES

Depression is a common and complex mental and emotional disorder that causes disability, morbidity, and quite often mortality around the world. Depression is closely related to several physical and metabolic conditions causing metabolic depression. Studies have indicated that there is a relationship between the intestinal microbiota and the brain, known as the gut-brain axis. While this microbiota-gut-brain connection is disturbed, dysfunctions of the brain, immune system, endocrine system, and gastrointestinal tract occur. Numerous studies show that intestinal dysbiosis characterized by abnormal microbiota and dysfunction of the microbiota-gut-brain axis could be a direct cause of mental and emotional disorders. Traditional treatment of depression includes psychotherapy and pharmacotherapy, and it mainly targets the brain. However, restoration of the intestinal microbiota and functions of the gut-brain axis via using probiotics, their metabolites, prebiotics, and healthy diet may alleviate depressive symptoms. Administration of probiotics labeled as psychobiotics and their metabolites as metabiotics, especially as an adjuvant to antidepressants, improves mental disorders. It is a new approach to the prevention, management, and treatment of mental and emotional illnesses, particularly major depressive disorder and metabolic depression. For the effectiveness of antidepressant therapy, psychobiotics should be administered at a dose higher than 1 billion CFU/day for at least 8 weeks.

Immunological aspects of probiotics for improving skin diseases: Influence on the Gut-Brain-Skin Axis

Article

Feb 2024
BIOCHEM BIOPH RES CO

The interplay between gut microbiota and human health, both mental and physical, is well-documented. This connection extends to the gut-brain-skin axis, linking gut microbiota to skin health. Recent studies have underscored the potential of probiotics and prebiotics to modulate gut microbiota, supported by in vivo and clinical investigations. In this comprehensive review, we explore the immunological implications of probiotics in influencing the gut-skin axis for the treatment and prevention of skin conditions, including psoriasis, acne, diabetic ulcers, atopic dermatitis, and skin cancer. Our analysis reveals that probiotics exert their effects by modulating cytokine production, whether administered orally or topically. Probiotics bolster skin defenses through the production of antimicrobial peptides and the induction of keratinocyte differentiation and regeneration. Yet, many questions surrounding probiotics remain unanswered, necessitating further exploration of their mechanisms of action in the context of skin diseases.

The Role of Probiotics in Skin Care: Advances, Challenges, and Future Needs

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