Sure, bacteria can cause pimples. But a healthy balance of bugs might clear them too.
If you’re dealing with acne, take heart in knowing that you’re not alone. According to the American Academy of Dermatology, it’s the most common skin condition in the United States, affecting up to 50 million Americans each year. Despite such prevalence, however, there's no one treatment that works for every acne sufferer. Instead, there’s a plethora of potential pimple-fighting approaches, from over-the-counter gels and creams to probiotics.
Yup, the live microorganisms (e.g. bacteria) best known for boosting gut health might also have the power to promote clear skin. Keyword being “might.” Ahead, more on why probiotics may be worth incorporating into your acne-fighting routine, according to experts.
The Connection Between Your Gut and Skin
Your gut is home to a wide array of good and bad bacteria known as the gut microbiome.
"The gut is the epicenter of health in so many ways," says Jordan Crofton, FNP, Director of Patient Care at THE WELL New York. "It’s the conductor for our health in every capacity, and when the bacteria in our gut aren’t happy, it’s hard for any bodily system to function well, including the skin."
Any number of factors — diet, stress, antibiotics — can throw the delicate balance of the gut microbiome out of whack, triggering what’s known as dysbiosis, explains Whitney Bowe, MD, board-certified dermatologist and founder of Dr. Whitney Bowe Beauty, a topical and ingestible skincare system. "Dysbiosis leads to increased intestinal permeability or leaky gut. This can cause inflammatory molecules that were in the gut [to] penetrate into the rest of the body and stimulate systemic inflammation. In the skin, this can show up in a number of ways, including acne flares."
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Crofton adds that gut dysbiosis can also play a role in hormonal imbalances, which have a direct impact on the skin too. More specifically, a part of the gut microbiome is responsible for how you metabolize hormones, particularly estrogen, she says. And when hormones are out of whack, sebum (oil) production can increase, upping the likelihood of breakouts.
"[The gut's] the conductor for our health in every capacity, and when the bacteria in our gut aren’t happy, it’s hard for any bodily system to function well, including the skin."
Your Skin Microbiome Also Plays a Role
Just as you have a whole system of bacteria living in your guts, so too is there one that lives on the skin. The skin microbiome refers to all of the billions of microorganisms — again, a combo of both good and bad bacteria — that reside on the surface of the skin.
"A lot of what can trigger acne has to do with an imbalance or dysbiosis of the skin microbiome," says Dr. Bowe. "When we lose the delicate balance and there’s an overgrowth of certain strains of bacteria, this can actually cause some skin conditions, such as acne." For example, C.acnes (neé P. acnes) is one bacteria known to be associated with acne. But there are a number of different strains of this microbe, some of which cause acne flares while others actually protect against the dermatological condition, she adds.
Previously, the approach to treating acne "was very much about wiping out all of the bacteria with things such as benzoyl peroxide, an ingredient with antibacterial properties, and antibiotics," Dr. Bowe explains. "But we’re now realizing that that’s not a long-term solution, and it’s more important to nourish and maintain a healthy diversity and balance of the microbiome — in both the skin and the gut."
Topical vs. Oral Probiotics for Acne
More and more skincare products now include probiotics, but take these claims with a grain of salt. "Probiotics are overrated in skin care," says Dr. Bowe. Most skincare formulas have water in them, which means they contain a preservative to prevent the overgrowth of any bad bacteria, but those preservatives also kill the probiotics, she explains.
What may be beneficial — and what many brands are now doing — is using topicals with prebiotics and postbiotics instead, she notes. Prebiotics are essentially food for probiotics; postbiotics are either substances that are released by probiotics or inactivated versions of live probiotics, according to a 2020 scientific article. Both are important and play a part in maintaining a balanced skin microbiome by helping good bugs thrive and keeping bad bugs in check. But because neither of them are living microorganisms, it’s much easier to formulate products that contain them, Dr. Bowe explains.
As far as oral probiotics go, they’ve been shown to reduce inflammation and a leaky gut, and more studies are underscoring the correlation between acne and the gut microbiome, notes Crofton. The caveat? "Not all probiotics are created equal. There are all different types [of probiotics] and some are more appropriate for different situations and types of gut dysbiosis,” she says.
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It can take a bit of trial and error to find out which oral probiotic works best for you, which is why it’s very helpful to work with a provider rather than simply picking one off the shelf, she adds. A rule of thumb: Check the supplement labels to make sure you opt for one that contains strains that have been shown to survive, adhere and function in the GI tract. (A good example? THE WELL Essential Probiotic as it includes 10 of the most well-researched probiotic strains gut health.)
That being said, it bears mentioning that you can also get probiotics by eating fermented foods, such as sauerkraut and yogurt, as well as foods rich in polyphenols (think: colorful fruits and veggies). Recent research shows that polyphenols both act as antioxidants (i.e. reduce inflammation) and help rebalance the skin microbiome without causing digestive issues, such as gas and bloating, notes Dr. Bowe. (Fermented foods on the other hand can lead to GI upset, especially when eaten in large amounts.)
Both experts interviewed underscore the fact that probiotics — in any form — are certainly not a magic bullet or quick fix for acne. "They’re one part of a much larger strategy, which involves approaching acne from every angle and really looking at the big picture," says Crofton, who. "You need to look at the root causes that drive it, which could be anything from hormonal imbalances to stress to micronutrient deficiencies to an imbalanced gut microbiome."
Dr. Bowe agrees, adding that while using a topical product with prebiotics or postbiotics is a good idea, it doesn’t necessarily replace tried-and-true ingredients that combat acne in a more direct manner, such as salicylic acid or retinoids. Instead, they can help maintain overall skin health — something that everyone, with or without acne, can benefit from.