# Role of Nutribiotics in Skin Care
## 5 Nutribiotics: An Opportunity to Improve Skin Health
### Acne
He followed up 300 patients who consumed commercial probiotics, that is, Lactinex( Benton, UK) tablets comprising a mixture of _L. acidophilus_ and _L. bulgarcius_. The protocol consisted of 8 days of an oral probiotic, a 2-week washout, and another 8 days of treatment. An improvement of 80% was found, with it being more notable in cases of inflammatory acne [140]. Later on, similar results were found in studies performed in patients under antibiotic therapy with supplementation of oral probiotics _L. acidophilus_ and _Bifidobacterium bifidum_ as adjuvant therapy [141]. In 2018, [PERSON] et al. [188] carried out a review of the main strains used in the treatment of acne and atopic dermatitis, finding that those that showed the highest potential to control acne were _Staphylococcus_, _Streptococcus_, _Lactococcus_, _Lactobacillus_, and _Enterococcus_, and _Vitroscilla filiformis_, _Staphylococcus epidermidis_, and species of _Lactobacillus_ and _Bifidobacterium_ in the treatment of atopic dermatitis. In addition, other studies demonstrated that antibiotics and oral probiotics can provide a synergistic effect, especially in inflammatory acne. A randomized, prospective open-label trial demonstrated that the consumption of _Lactobacillus acidophilus_, _Lactobacillus delbrueckii_ subsp. _bulgarcius_, and _B. bifidum_ was as effective as minocycline in the treatment of acne, with a 67% reduction in lesions after twelve weeks of oral treatment, finding fewer side effects [133]. Another randomized controlled study with twenty subjects showed that the oral administration of _Lactobacillus rhamnus_ SP1 concluded with an improvement or marked improvement in adult acne compared to the placebo [142]. Researchers also measured gene expression on the skin of IGF-1, a hormone involved in acne development, and FOXO01, a transcription factor whose deficiency is associated with acne pathogenesis. The intervention also showed a 32% reduction in IGF-1 and a 65% increase in FOXO01 [142]. Other studies focused on interleukin-10 serum levels in acne vulgaris before and after 30 days of oral probiotics, which was a sachet containing _B. lactis_ W51, _B. lactis_ W52, _L. acidophilus_ W55, _L. casei_ W56, _L. salivarius_ W57, and _L. lactis_ W58 with total bacterial cells \(>10^{8}\) CFU. Results showed a significant increase in IL-10 levels after this therapy [143]. Additionally, in an in vitro cell culture skin model, the probiotic strain _Lactobacillus paracasei_ NCC2461 demonstrated dose-dependent inhibition of CD-4+ T cell activation and induction of the anti-inflammatory cytokines IL-10 and TGF-b [144]. Moreover, in a review performed by [PERSON] et al. [189], the authors concluded that probiotics can be effective as an adjunct therapy both in topical or oral administrations by preventing the growth of opportunistic bacteria or by controlling inflammation. They suggested that, despite numerous in vitro and in vivo studies, interventional studies using more samples and long-term follow-ups to demonstrate the effectiveness of these type of probiotics and determine potential advantages and disadvantages are needed. Other studies combine probiotics and plants in oral formulations. For example, [PERSON] et al. [190] conducted a double-blind clinical trial in men with mild to moderate acne treated with an oral supplement containing probiotics, biotin, vitamin E, zinc, nicotinamide, beta-sitosterol, and _Boswellia sernta_ extract. After 12 weeks of treatment, these patients presented clinical improvement, which was shown by the reduction in the Global Acne Grading System (GAGS) score [190]. Oral synbiotics were also investigated. In 2010, [PERSON] et al. [145] studied the capacity of konjac glucomannan hydrolysates and probiotics (_L. casei_, _L. plantarum_, _L. gasseri_, _L. lactis_) to inhibit C. _acnes_, finding that significantly inhibited the growth of bacteria, suggesting further research to confirm the use of this type of synbiotics as a therapeutic or prophylactic [145].