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The Microbiome & Implications in Aesthetics


While clinical data support certain oral and topical pre-, pro- and postbiotic products for some dermatologic conditions, Dr. Anna Chacon examines potential applications in the aesthetic specialty.

As physicians who specialize in treating the skin, we need to be mindful of beneficial bacteria in skincare.

The skin and microbiome are highly interconnected, particularly in the areas of pre-, pro- and postbiotics. We know that commensal bacteria are a major factor in human health and the pathogenesis of various medical conditions; however, interest has expanded beyond disease pathogenesis and the gastrointestinal microbiome to include that of the skin and impact in aesthetics.

We know that a diverse microbiome is associated with healthier skin, and an overgrowth of abnormal bacteria is associated with unhealthy skin or skin disease.

Researchers have examined the role of the microbiome in dermatology, considering both the microflora of the gut as well as the skin. While clinical data support the utility of certain oral and topical products (pre-, pro- and postbiotics) for certain dermatologic conditions, could these or similar recommendations also apply in the aesthetic specialty?

Cosmeceuticals with pre-, pro- and postbiotics may be useful in treating multiple aspects in skincare and dermatologic conditions, according to Joshua Zeichner, M.D.,Director of Cosmetic & Clinical Research in Dermatology at Mount Sinai Hospital in New York City.

Cosmeceuticals and cosmetic formulations contain preservatives that are intended to prevent contamination with bacteria. This prevents a presence of live bacteria in many skincare products. Instead of true probiotics, cosmetic products contain prebiotics, and extracts of probiotics or postbiotics. While there is data showing that this could be beneficial in restoring healthier looking skin, there is insufficient data showing if probiotic skincare is more effective than traditional products.1

Commercialization of the skin microbiome is currently taking two approaches:maintaining viable bacteria in live bacterial products — which can prolong benefits by colonizing the skin — and the use of bacterial products called lysates that prove a practical solution to the challenges of handling live bacteria, including keeping specific bacteria alive and limiting contaminants. With studies2 suggesting that lysates aid in protection against inflammation and improve barrier function, these bacterial-based products may be effective in improving skin appearance and health.

While we know that pathogenic bacteria on the skin is linked to a wide range of dermatologic diseases, the implications of cosmetic factors such as aging, body odor and blocked sebaceous glands are huge regarding product development and treatment recommendations.

A study3 conducted in Japan consisting of two different age groups — 21 to 37 and 60 to 76 —showed a striking alteration and diversification in the skin microbiome with aging, supporting this theory.

Current data supports the use of probiotics in the prevention and treatment of skin diseases, including acne vulgaris, atopic dermatitis and eczema, psoriasis, seborrheic dermatitis, skin cancer and chronic wounds. Still, more research and studies are needed to confirm these results, including which products can be safely recommended to patients.

Oral and topical probiotics appear to be effective for the treatment of certain inflammatory skin conditions, even demonstrating a promising future within wound healing and cutaneous oncology. Thus, oral and topical probiotics may have a future role in expediting wound healing after certain minimally invasive cosmetic procedures, like injectables, lasers and tumescent liposuction.

In consumer media, the skin microbiome was recognized by popular publications Vogue and Harper’s Bazaar as one of 2019’s biggest skincare trends.

With a scientific understanding of the skin microbiome taking the potential for modulation into new territories, now is the time for understanding, applying and developing products that influence the skin’s health through the microbiome.

Next: A Closer Look: Prebiotics, Probiotics and Postbiotics


1. Zeichner, J. 2018. Microbiome and the Skin. Fall Clinical Dermatology Conference, Las Vegas. October 18, 2018.

2. Khmaladze I, Butler É, Fabre S, Gillbro JM. Lactobacillus reuteri DSM 17938-A comparative study on the effect of probiotics and lysates on human skin. Exp Dermatol. 2019;28(7):822-828.

3. Shibagaki N, Suda W, Clavaud C, et al. Aging-related changes in the diversity of women's skin microbiomes associated with oral bacteria. Sci Rep. 2017;7(1):10567.

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