Probiotics for Treating Acne & Its Uses - Studies

Probiotics have gained popularity as emerging research continues to highlight their potential benefits for various health conditions. The most studied probiotics for acne are:

• Lactobacillus acidophilus
• Lactobacillus delbrueckii bulgaricuss
• Bifidobacterium bifidum
• Lactobacillus rhamnosus SP1

Holistic medicine views the body as a whole with every organ system connected to one another. It recognizes just how important addressing every system is for overall health. Individuals suffering from acne may be suffering from other conditions concurrently. In addition to relieving some symptoms of acne, these probiotic strains may be beneficial for several other aspects of health such as vaginal health, intestinal inflammation, immunity, cholesterol, liver function, fatigue, dental health, and more. This article will review other health conditions these probiotic strains have been studied for.

Lactobacillus acidophilus

Lactobacillus acidophilus has been studied for:

• Improving vaginal health
• Reducing intestinal inflammation
• Relieving diarrhea
• Lactose intolerance
• Improving immune support
• Reducing cholesterol

Improving vaginal health

Lactobacillus acidophilus has shown efficacy for bacterial vaginosis, vulvovaginal candidiasis, and genitourinary syndrome of menopause.

Bacterial vaginosis occurs due to the presence of abnormal vaginal microbiota and a reduction in the lactobacilli strains.^[1] A double-blinded placebo-controlled trial evaluated the use of a probiotic mixture containing Lactobacillus acidophilus GLA-14 and Lactobacillus rhamnosus HN001 with bovine lactoferrin in addition to metronidazole in women with recurrent bacterial vaginosis.^[1] After 6 months of treatment with the probiotic, vaginal discharge, itching, Nugent scores, and recurrence rates were significantly improved in the probiotic group.^[1]

This same probiotic combination was evaluated for its efficacy as an adjunct therapy to topical clotrimazole in individuals with recurrent vulvovaginal candidiasis.^[2] The probiotic group in the study was superior to placebo in reducing itching and discharge within three and six months of treatment.^[2]

A randomized clinical trial compared the use of an oral isoflavone alone, an oral isoflavone with probiotics, or hormone therapy in 60 postmenopausal women over 16 weeks.^[3] The probiotics used were Lactobacillus acidophilus, Lactobacillus casei, Lactococcus lactis, Bifidobacterium bifidum, and Bifidobacterium lactis.^[3] While the isoflavone group plus probiotic did improve vaginal health scores, it did not provide an estrogenic effect to relieve the menopausal related vulvovaginal symptoms, whereas the hormone group did.^[3]

Reducing intestinal inflammation

Probiotics have been used to reduce intestinal inflammation in inflammatory bowel disease and necrotizing enterocolitis.^[4] Pathophysiology of these conditions include production of a variety of lipid mediators, including platelet-activating factor.^[4]

The soluble factors on the cell surface of L. acidophilus were found to counteract the platelet-activating factor (PAF)-induced inflammatory cascade.^[4] Colitis improvement is thought to be controlled by L. acidophilus strain ATCC-4356 through regulation of the Notch pathway.^[5] Alterations of the gut microbiome, barrier function and the selection of inflammatory cytokines were observed in rats with ulcerative colitis treated with L. acidophilus CGMCC 7282 and C. butyricum CGMCC 7281.^[6] The combination of L. acidophilus CGMCC 7282 and C. butyricum CGMCC 7281 had a stronger anti-inflammatory effect than either of the individual strains alone in vitro.^[6]

A double-blinded randomized placebo-controlled trial evaluated a probiotic combination of Lactobacillus acidophilus CL1285, Lactobacillus casei LBC80R, and Lactobacillus rhamnosus CLR2 in individuals with irritable bowel syndrome symptoms including constipation, diarrhea, or a mix of both over 12 weeks. Females experiencing diarrhea symptoms had the most beneficial and consistent effects after using the probiotic.^[7]

Lactose intolerance

The L. acidophilus NCFM strain has been shown to reduce symptoms associated with lactose intolerance.^[8] L. acidophilus has been shown to produce β-galactosidase, an enzyme able to hydrolyze lactose.^[9] An RCT found L. acidophilus DDS-1 to improve abdominal symptom scores compared to placebo with respect to diarrhea, cramping, and vomiting during acute lactose intolerance episodes.^[10]

Relieving diarrhea

Diarrhea may occur when apical Cl⁻/OH⁻ ion exchange activity is inhibited by phorbol esters, nitric oxide, serotonin, and E.coli infection.^[11] 

Live L. acidophilus was found to secrete soluble fibers that stimulate Cl⁻/OH⁻ ion exchange, improving electrolyte absorption.^[11] Looking at other ion exchangers, one study demonstrated soluble effector molecules secreted by L. acidophilus to increase Na⁺/H⁺ exchange activity through modulation of NHE3 expression and function.^[12] The soluble factors of L. acidophilus have previously been shown to stimulate Cl⁻/HCO3− exchange activity in vitro as well as in vivo.^[12]

Another study showed that Salmonella treated with L. acidophilus LB culture or LB-CFCS had a transient loss of swimming motility.^[13] Previous findings have observed the presence of LPS and salmonella motility to be linked.^[13]

Improving immune support

1. L. acidophilus NCFM has been found to upregulate genes that induce production of cytokines including IFN-β, TLR-3, IL-12, and IL-10 in dendritic cells.^[14] Dendritic cells are key regulators of the immune response that interact with several antigens, bacteria, viruses, etc.^[14] The NCFM strain was shown to induce strong expression of viral defense genes as well.^[14] The S-layer protein found in L. acidophilus ATCC-4356 was found to stimulate an immune response and inhibit H9N2 avian influenza virus invasion of dendritic cells while also stimulating the IFN-I signaling pathway.^[15]

Reducing cholesterol

Several studies have shown cholesterol to be incorporated into L. acidophilus or adhering to the bacterial cell membrane.^[16] These incorporated cholesterols are less likely to be absorbed by the intestines and enter the bloodstream.^[16] In a rat study, serum cholesterol levels were reduced by 25% after feeding of L. acidophilus for four weeks.^[16] Another study identified L. acidophilus K301 to regulate the expression of genes related to cholesterol reverse transport through the induction of endogenous LXR agonist.^[17] L. acidophilus K301 seems to inhibit cholesterol biosynthesis by degrading 3-hydroxy-3-methylglutaryl-CoA reductase (HMGR), an enzyme involved in the synthesis of sterols such as cholesterol. This suggests its therapeutic potential for preventing atherosclerosis.^[17]

Lactobacillus delbrueckii bulgaricuss

Lactobacillus delbrueckii bulgaricuss has been studied for:

• Reducing fatigue
• Improving immune support

Reducing fatigue

Autonomic nervous system imbalances are thought to place a role in chronic fatigue syndrome.^[18] A randomized controlled trial showed that individuals experiencing summer heat fatigue who consumed yogurt fermented with Lactobacillus bulgaricus OLL1073R-1 had improved VAS fatigue scores.^[18] Blood pressure recovery was detected after temperature fluctuations in the yogurt group.^[18] One of the active components thought to contribute to these beneficial effects is exopolysaccharide (EPS) produced by Lactobacillus bulgaricuss.^[18] EPS has been shown to initiate INF-gamma production and increase NK cell activity in mice, although not confirmed in human studies.^[18]

Improving immune support

Lactobacillus delbrueckii ssp. bulgaricus OLL1073R-1 and Lactobacillus delbrueckii ssp. bulgaricus 8481 have been suggested to increase immunity and reduce the risk of infection in elderly individuals.^[19] Salivary IgA plays a role in immune function in the oral cavity and levels are thought to decrease with age. In fact, low levels of salivary IgA have been associated with increased upper respiratory infections.^[19] A before-and-after nonrandomized intervention study found that elderly individuals who consumed yogurt fermented with Lactobacillus delbrueckii ssp. bulgaricus OLL1073R-1 for 12 weeks had an increase in their salivary IgA levels.^[19]

A multi-center, double-blind, and placebo-controlled study gave elderly individuals 3 capsules of a probiotic supplement containing L. delbrueckii ssp. bulgaricus 8481 over 6 months and found increased T cell subsets & NK cells, improved immune risk profile parameters, and decreased concentrations of proinflammatory cytokine IL-8.^[20] It was noted that 6 months after discontinuing the probiotic supplementation, the blood work of these individuals did not maintain the previously mentioned immune function markers.^[20]

Bifidobacterium bifidum

Bifidobacterium bifidum has been studied for its use for:

• Relieving GI discomfort & IBS
• Relieving symptoms of seasonal allergies
• Improving liver function in patients with NAFLD

Relieving GI discomfort & IBS

A study was conducted in 100 Japanese individuals suffering from gastrointestinal disorders to evaluate whether the consumption of milk fermented with Bifidobacterium bifidum YIT 10347 can lead to relief of gastrointestinal symptoms.^[21] After 4 weeks of use, individuals taking the probiotic milk had relief of gastrointestinal symptoms according to the modified Frequency Scale for Symptoms of Gastroesophageal Reflux Disease (m-FSSG) and the Gastrointestinal Symptom Rating Scale (GSRS).^[21] The probiotic milk group experienced significant relief of diarrhea, postprandial discomfort, flatus, epigastric pain, and upper gastrointestinal symptoms.^[21]

Relieving symptoms of seasonal allergies

A probiotic containing L. gasseri KS-13, Bifidobacterium bifidum G9-1, and B. longum MM-2 has been found to reduce the allergen response by stimulating peripheral blood cell production of IL-10 in vitro.^[22] A double-blind, placebo-controlled trial found an improvement in MRQLQ global scores from baseline to pollen peak compared to the placebo group.^[22] While the exact mechanism is unknown, total IgE and T regulatory cells increased after 6 weeks in both the placebo and treatment group.^[22] 

Improving liver function in patients with NAFLD

The benefits of probiotics in non-alcoholic fatty liver disease is beginning to be understood.^[23] More research is needed, but current data suggest that microbial products, enzymes, and dysbiosis balancing effects of probiotics may be helpful for improving liver function.^[23] One randomized placebo-controlled trial used a combination of Lactobacillus acidophilus ATCC B3208, Bifidobacterium lactis DSMZ 32269, Bifidobacterium bifidum ATCC SD6576, and Lactobacillus rhamnosus DMZ 21690 in pediatric patients with NAFLD.^[24] After 12 weeks on the probiotics, liver function markers such as alanine aminotransferase, and mean aspartate aminotransferase decreased by 9.9 U/L and 7.7 U/L.^[24] A normal liver sonography was seen in 17 individuals in the probiotic group and 5 individuals in the placebo group.^[24]

Lactobacillus rhamnosus SP1

Lactobacillus rhamnosus SP1 has been studied for:

• Improving dental health

Improving dental health

Some studies have evaluated the strain Lactobacillus rhamnosus SP1 in individuals with chronic periodontitis and dental caries.

Supplementation with Lactobacillus rhamnosus SP1 alongside scaling and root planning showed similar clinical improvements as the placebo with scaling and root planning group.^[25] While they had similar results, the probiotic group had a statistically significant reduction in probing depths after a one year follow up compared to the placebo group, which suggests a lesser need for surgery.^[25] A subsequent study demonstrated that the same strain of probiotic alongside scaling and root planning had attachment gain and reduced plaque formation, although not statistically significant.^[26]

A cluster randomized trial evaluated the use of Lactobacillus rhamnosus SP1 in pre-school children with a high risk for dental caries.^[27] The probiotic was mixed in with milk and given to children for 40 weeks.^[27] The children who had the milk containing the probiotic had less of an increase of new dental caries than the control group who took milk alone.^[27] The dentists were blinded to the groups during their evaluations.^[27] The exact mechanism of action is unknown but probiotics may be a potential intervention to consider for managing dental caries.^[27]

Practical Tips

• Probiotics species used for acne such as Lactobacillus acidophilus, Lactobacillus delbrueckii bulgaricuss, Bifidobacterium bifidum, Lactobacillus rhamnosus SP1 can also help improve vaginal health, intestinal inflammation, immunity, cholesterol, liver function, fatigue, and dental health.
• With a holistic view in treating acne patients, clinicians may inquire about the above conditions and counsel patients that probiotics may help improve their other health ailments as well as acne.