Jung, G., Tse, J., Guiha, I., & Rao, J. (2013). Prospective, Randomized, Open-Label Trial Comparing the Safety, Efficacy, and Tolerability of an Acne Treatment Regimen with and without a Probiotic Supplement and Minocycline in Subjects with Mild to Moderate Acne. Journal of Cutaneous Medicine and Surgery, 17, 114 - 122. https://doi.org/10.2310/7750.2012.12026.
Rybak, I., Haas, K., Dhaliwal, S., Burney, W., Pourang, A., Sandhu, S., Maloh, J., Newman, J., Crawford, R., & Sivamani, R. (2023). Prospective Placebo-Controlled Assessment of Spore-Based Probiotic Supplementation on Sebum Production, Skin Barrier Function, and Acne. Journal of Clinical Medicine, 12. https://doi.org/10.3390/jcm12030895.
Kwon, H., Yoon, J., Park, S., Min, S., & Suh, D. (2014). Comparison of Clinical and Histological Effects between Lactobacillus-Fermented Chamaecyparis obtusa and Tea Tree Oil for the Treatment of Acne: An Eight-Week Double-Blind Randomized Controlled Split-Face Study. Dermatology, 229, 102 - 109. https://doi.org/10.1159/000362491.
Fabbrocini, G., Bertona, M., Picazo, Ó., Pareja-Galeano, H., Monfrecola, G., & Emanuele, E. (2016). Supplementation with Lactobacillus rhamnosus SP1 normalises skin expression of genes implicated in insulin signalling and improves adult acne.. Beneficial microbes, 7 5, 625-630 . https://doi.org/10.3920/BM2016.0089. # Mouse model

" Conclusions: LGG co-association had a negative impact on colonization of P. acnes, and markedly altered the metabolic output and inflammatory response elicited by pathobionts. " Kim, Jinhee et al. “Lactobacillus rhamnosus GG modifies the metabolome of pathobionts in gnotobiotic mice.” BMC microbiology vol. 21,1 165. 3 Jun. 2021, doi:10.1186/s12866-021-02178-2 (edited)

Eguren, C., Navarro-Blasco, A., Corral-Forteza, M., Reolid-Pérez, A., Setó-Torrent, N., García-Navarro, A., Prieto-Merino, D., Núñez-Delegido, E., Sánchez-Pellicer, P., & Navarro-López, V. (2024). A Randomized Clinical Trial to Evaluate the Efficacy of an Oral Probiotic in Acne Vulgaris. Acta dermato-venereologica, 104, adv33206. https://doi.org/10.2340/actadv.v104.33206
- Conflict of interest statement: EN-D, PS-P and VN-L are employees of Bioithas (a sister company of Bionou Research) and VN-L owns stock/stock options.
Carlomagno, F., Pesciaroli, C., Cestone, E., Ponti, I., Michelotti, A., & Tursi, F. (2022). Clinical assessment on the efficacy of a combined treatment targeting subjects with acne-prone skin. Our Dermatology Online. https://doi.org/10.7241/ourd.20223.1. ## Lactobacillus plantarum
Kim, M., Kim, K., Choi, E., Yim, J., Choi, C., Yun, H., Ahn, H., Oh, J., & Cho, Y. (2021). Effects of Lactobacillus plantarum CJLP55 on Clinical Improvement, Skin Condition and Urine Bacterial Extracellular Vesicles in Patients with Acne Vulgaris: A Randomized, Double-Blind, Placebo-Controlled Study. Nutrients, 13. https://doi.org/10.3390/nu13041368.
Ai, J., Ma, W., Pan, Z., Mao, B., Tang, X., Zhang, Q., Zhao, J., Chen, W., & Cui, S. (2024). Ameliorative effect of Lactobacillus plantarum CCFM8661 on oleic acid-induced acne: integrated gut microbiota link to acne pathogenesis. Journal of the science of food and agriculture, 104(1), 328–339. https://doi.org/10.1002/jsfa.12921
Liang, L., Qi, X., Jiang, X., Chen, T., & Dong, L. (2024). Lactobacillus plantarum MH-301 as an effective adjuvant to isotretinoin in the treatment of acne vulgaris: a randomized and open-label trail. Frontiers in medicine, 10, 1340068. https://doi.org/10.3389/fmed.2023.1340068

(edited)

Marasca, C., Ruggiero, A., Cacciapuoti, S., Fabbrocini, G., & Annunziata, M. (2022). Probiotic supplement combined with topical therapy in the treatment of mild to moderate acne: results from an Italian single centre interventional study.. Italian journal of dermatology and venereology. https://doi.org/10.23736/S2784-8671.22.07361-3. Rinaldi, F., Marotta, L., Mascolo, A., Amoruso, A., Pane, M., Giuliani, G., & Pinto, D. (2022). Facial Acne: A Randomized, Double-Blind, Placebo-Controlled Study on the Clinical Efficacy of a Symbiotic Dietary Supplement. Dermatology and therapy, 12(2), 577–589. https://doi.org/10.1007/s13555-021-00664-z Manfredini, M., Sticchi, A., Lippolis, N., Pedroni, G., Giovani, M., Ciardo, S., Chello, C., Guida, S., Farnetani, F., & Pellacani, G. (2023). Characterization of Acne-Prone Skin with Reflectance Confocal Microscopy and Optical Coherence Tomography and Modifications Induced by Topical Treatment and Probiotic Supplementation. Journal of clinical medicine, 12(14), 4787. https://doi.org/10.3390/jcm12144787 Rather, I. A., Kim, B. C., Lew, L. C., Cha, S. K., Lee, J. H., Nam, G. J., Majumder, R., Lim, J., Lim, S. K., Seo, Y. J., & Park, Y. H. (2021). Oral Administration of Live and Dead Cells of Lactobacillus sakei proBio65 Alleviated Atopic Dermatitis in Children and Adolescents: a Randomized, Double-Blind, and Placebo-Controlled Study. Probiotics and antimicrobial proteins, 13(2), 315–326. https://doi.org/10.1007/s12602-020-09654-7 Kimoto-Nira, H., Aoki, R., Sasaki, K., Suzuki, C., & Mizumachi, K. (2012). Oral intake of heat-killed cells of Lactococcus lactis strain H61 promotes skin health in women. Journal of nutritional science, 1, e18. https://doi.org/10.1017/jns.2012.22 (edited)

Potential side effects:

Generally considered safe, but can cause issues in immunocompromised individuals
Rare cases of sepsis or fungemia in critically ill patients
Possible stomach upset, bloating, or diarrhea in some individuals

Marco Alexandre Dias da Rocha, Sergio Schalka, Fernanda Calvente Bayan et al. The efficacy of an oral probiotic associated with a fixed combination of benzoyl peroxide and adapalene in the treatment of acne: A randomized, double-blind, placebo-controlled clinical trial., 14 November 2022, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-2227654/v1]
- Conflict of interest: The authors declare a conflict of interest with DIVCOM-Farmoquímica S.A.

(edited)

Topical probiotic vs benzoyl peroxide

"Conclusion: Probiotic-derived lotion is safe and effective for treating mild to moderate acne vulgaris, a comparable outcome with 2.5% benzoyl peroxide. It could be an alternative treatment of acne with more minor side effects." Efficacy of probiotic-derived lotion from Lactobacillus paracasei MSMC 39-1 in mild to moderate acne vulgaris, randomized controlled trial (edited)

In vitro - oral microbiome related

“L. salivarius LS03 exerted a significant inhibitory capacity against the target pathogen strain” Deidda F, Amoruso A, Nicola S, Graziano T, Pane M, Mogna L. New Approach in Acne Therapy: A Specific Bacteriocin Activity and a Targeted Anti IL-8 Property in Just 1 Probiotic Strain, the L. salivarius LS03. J Clin Gastroenterol. 2018 Nov/Dec;52 Suppl 1, Proceedings from the 9th Probiotics, Prebiotics and New Foods, Nutraceuticals and Botanicals for Nutrition & Human and Microbiota Health Meeting, held in Rome, Italy from September 10 to 12, 2017:S78-S81. doi: 10.1097/MCG.0000000000001053. PMID: 29782471. (edited)

10:28 AM

Topical bacteriocins

“Topical bacteriocins from B. subtilis can promote S. aureus decolonization in acneic skin” Alessandrini G, Mercuri SR, Martella A, Ferrara F, Simonetti V, Trifirò C, Emanuele E. Topical application of bacteriocins from Bacillus subtilis promotes Staphylococcus aureus decolonization in acneic skin and improves the clinical appearance of mild-to-moderate acne. Postepy Dermatol Alergol. 2023 Feb;40(1):115-118. doi: 10.5114/ada.2022.124108. Epub 2023 Jan 13. PMID: 36909897; PMCID: PMC9993192. Conflict of interest statement This study was partly funded by Biodue SpA. (edited)

"Conclusions: This specific probiotic formulation may help improving acne symptoms, offering a possible adjuvant therapy to the conventional one and thus overall ameliorating the patient’s quality of life." Shi, Zhifeng, et al. "Investigating the impact of oral probiotic supplementation for acne management: A randomized controlled trial." "Conclusion: The combined treatment proposed, formulated to target both gut and skin microbiota, resulted effective in ameliorating acne clinical signs and could represent a valid alternative to conventional acne management." Carlomagno, Federica, et al. "Clinical assessment on the efficacy of a combined treatment targeting subjects with acne-prone skin." Our Dermatol Online 13 (2022): 240-7.

Azithromycin vs probiotics

"Conclusion: Probiotics have equal efficacy to azithromycin, and their combination has shown synergistic effects for the treatment of acne vulgaris. Probiotics should be used in combination with azithromycin for the best results for the management of acne vulgaris." Irshad, Mushayada et al. “Comparative Effects of Azithromycin and Probiotics for Treatment of Acne Vulgaris.” Journal of the College of Physicians and Surgeons--Pakistan : JCPSP vol. 33,5 (2023): 516-520. doi:10.29271/jcpsp.2023.05.516