# Role of Nutribiotics in Skin Care
## 5 Nutribiotics: An Opportunity to Improve Skin Health
### Acne
The _Escherichia coli_ Nissle 1917 strain has also been used in clinical trials in patients with acne. [PERSON] et al. [146] performed a study in which this strain was orally administered to 82 patients with intestinal-borne dermatoses (some of them were diagnosed with acne, and others with papular-pustular rosacea and seborrheic dermatitis). They compared two groups of patients: one group of patients were treated with conventional topical therapy, and other with the probiotic _E. coli_ Nissle 1917 strain administered orally for one month. A total of 89% of the patients treated with _E. coli_ Nissle 1917 improved significantly, while 56% improved in the group treated with the conventional therapy. After studying the composition of gut microbiota and other parameters, the authors concluded that the _E. coli_ Nissle 1917 strain was able to restore the intestinal microbiota, protect the intestinal barrier, and ameliorate the mentioned diseases [146]. [PERSON] et al. [147] evaluated the efficacy of a mixture of the probiotic strains _Bifidobacterium breve_ BR03 DSM 16604, _Lacticaseibacillus casei_ LC03 DSM 27537, and _Ligilactobacillus salivarius_ LS03 DSM 22776 combined with a botanical extract of _Solanum melongena_ and _Echinacea_ in subjects with mild to moderate acne over an 8-week study period through a randomized, placebo-controlled clinical trial. Results showed a decreased presence of _C. acnes_, number of acne lesions, rate of sebum secretion, and rate of desquamation in patients who were treated with the probiotic mixture and the botanical extract as well as the mixture of both, concerning placebo treatment. The most notable effects were observed with the probiotic mix plus the botanical extract [147]. The ammonia-oxidizing bacteria _Nitrosomonas eutropha_ was also used to treat adult patients with mild or moderate acne, finding that, after 12 weeks of treatment, a significant reduction in overall severity was seen, along with as a tendency of a reduction in the number of inflammatory lesions compared to the control group [148]. Topic probiotics could also be useful in treating acne. The production of short-chain fatty acids (such as succinic acid) on the skin can inhibit _C. acnes_ growth [191]. Lactic acid [192] and ceramide [193] produced after topical probiotic administration showed direct antimicrobial activity against _C. acnes_. Additionally, [PERSON] et al. [194] used a cell-free culture supernatant from _E. faecalis_ SL-5 in patients with mild to moderate acne with a topical application. The study concluded that this bacteriocin was able to reduce inflammation; thus, researchers suggested that _E. faecalis_ could be an alternative option in future acne therapy [194]. Additionally, a bacteriocin produced by _Lactococcus_ sp. HY499 exerted an inhibitory effect on inflammatory and pathogenic bacteria in the skin, such as _S. epidermidis, Staphylococcus aureus, S. pyogenes_, and _P. acnes_, without affecting the growth and proliferation of fibroblasts. The authors recommended this bacteriocin as an antimicrobial in cosmetic formulations [195].