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Clinical Efficacy of Probiotics in the Treatment of Patients With Acne Vulgaris
abstract
This abstract is available on the publisher's site.
Access this abstract nowAcne vulgaris is a chronic skin disease characterized by inflammation, microbial colonization, and increased sebum production. Literature suggests Cutibacterium acnes dysbiosis favoring pathologic strains may contribute to the pathogenesis of acne. Pathogenic strains of C. acnes cause a more potent inflammatory response compared to less-associated strains. Staphylococcus epidermidis, a commensal bacterium of the normal flora, has been found to inhibit C. acnes growth and related skin inflammation, and any imbalance between these two populations contributes to this dysbiosis. The gut microbiota and their products play a crucial role in the gut–skin-axis, defined as the connection between cutaneous and digestive environments mediated by metabolites, the neuroendocrine system, and the central nervous system. As there is no existing comprehensive systematic review of human studies evaluating oral and topical probiotics, this review summarizes existing randomized controlled trials (RCTs) and self-controlled clinical trials evaluating the clinical efficacy of probiotics in treating acne vulgaris.
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Using probiotics to treat acne vulgaris: systematic review
Arch Dermatol Res 2024 Mar 12;316(4)101, A Boby, G Lee, N Natarelli, L CorreaFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Paracelsus, the great physician and father of toxicology and balneology, once implored clinicians to "seek, knock, and find." These words resonate profoundly as we strive to uncover deeper understanding and innovative treatment for skin diseases. Despite decades of advancements in modern therapeutics, acne continues to challenge us and vex our patients.
It has been incredibly exciting to watch the microbiome unfold as a new frontier for both understanding and treating skin diseases.1 Yet, the microbiome remains opaque and elusive with tremendous complexity; it refuses to yield its secrets easily. It seems increasingly likely that advanced bioinformatics with machine learning will need to be applied to large data sets in order to tame this enormous domain.2 It is far beyond the quixotic simplicity of "one gene, one enzyme," and even that we realize was flawed from the beginning.3
In this systematic review, Boby et al very concisely summarize nine clinical studies using topical and oral probiotics for acne vulgaris. I must say that it is the absolute shortest systematic review I have ever seen, and I appreciate the brevity — they got straight to the point. That said, it is difficult to say much at all. Each study was quite different and we are left with all showing some positive effects, but 4 of the 9 studies had Jadad scores less than 5, and all of the studies were fairly small. It was almost comical that one study did not even specify the type of probiotics they used!4
I remain bullish on the idea that the microbiome is an important frontier in medicine but also humbled by its overwhelming multiplicity. I think we have ways to go yet, but I am excited to continue on this journey.
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