# Role of Nutribiotics in Skin Care
## 5 Nutribiotics: An Opportunity to Improve Skin Health
### Atopic Dermatitis
On the skin, bacterial counts of the _genus Bifidobacterium_ versus _Clostridium coccoides_ in treated and untreated infants were similar [155]. Additionally, the oral administration of probiotic bacteria _Bifidobacterium lactis_ HN019 and _Lactobacillus rhamous_ HN001 has been observed to improve natural killer cells and phagocytic activity [156]. Later studies showed that AD symptoms can be improved using _Lactobacillus paracasei_ KBL382 isolated from the feces of healthy Koreans. In this study, mice with _Dermatophagoides farinae_ extract (DFE)-induced AD were fed with _L. paracasei_ KBL382 for 4 weeks, demonstrating that oral administration of _L. paracasei_ KBL382 significantly reduced AD-associated skin lesions, epidermal thickening and serum levels of immunoglobulin E, and immune cell infiltration. Furthermore, the administration of _L. paracasei_ KBL382 was able to change the gut microbiota composition in mice with AD [202]. Several studies focus on oral probiotic supplementation during pregnancy and breastfeeding. [PERSON] et al. [203] revised the efficacy of the most commonly studied probiotic strains for the prevention and treatment of AD, concluding that probiotic supplementation during the prenatal and postnatal periods seems to reduce the incidence of AD in infants and children who are at high risk, especially beginning in gestation and through the first 6 months of life. The revised studies included monostrain probiotics such as _Bifidobacterium dentium_[204], _Lactobacillus rhamnus_ MP108 [205], and heat-treated _Lactobacillus paracasei_[206]; multi-strain probiotics such as _Lactobacillus acidophilus_ La-5, and _Bifidobacterium animalis_ subsp. lactis Bb-12 [207], _Lactobacillus paracasei_ and _Lactobacillus fermentum_[208]; _Lactobacillus rhamnus_ and _Bifidobacterium animalis_ subsp. lactis [209]; and multi-strain _Bifidobacterium lactis_ CECT 8145, _B. longum_ CECT 7347, and _Lactobacillus casei_ CECT 9104 [210]. A systematic review and meta-analysis of randomized controlled trials performed by [PERSON] et al. [211] concluded that probiotic supplementation during the last trimester of pregnancy or breastfeeding could reduce the risk of eczema in infants, although the certainty of the evidence was low. [PERSON] et al. [212] achieved similar findings, concluding that the use of probiotics during both the prenatal and the postnatal period significantly reduced the incidence of AD; however, the analysis of studies of probiotics administered prenatally only or postnatally only did not reach statistical significance. Similarly, [PERSON] et al. [213] revised randomized clinical trials related to the use of oral probiotics to prevent AD, finding that the top 3 probiotic preparations in terms of efficacy in reducing the risk of AD are multi-strain _Lactobacillus paracasei_ ST11, _Bifidobacterium longum_ BL999, and _Lactobacillus paracasei_ ssp. _paracasei_ F19, _Lactobacillus rhamnus_ GG, and _Bifidobacterium animalis_ ssp. _lactis_ Bb-12. Recently, a meta-analysis and systematic review performed by [PERSON] et al. [214] evaluated the efficacy of probiotic supplementation for the prevention of AD in infants, showing that oral probiotic supplementation in both mothers and infants was effective in preventing AD in infants. Synbiotics also seem to be useful in AD. Children with mild to moderate AD, aged 1 to 10 years, were treated with one sachet of a novel synbiotics formula daily, which contained a mixture of six types of gastro-resistant probiotics (not less than \(1.5\times 10^{10}\) CFU/sachet at the time of production), and triple prebiotics containing inulin, isomalto-oligosaccharides, and fruct-oligosaccharides for 8 weeks. The probiotic mixture was composed of _Lactobacillus rhamnus_ GG, _Lactobacillus acidophilus_ GKA7, _Bifidobacterium longum_ GKL7, _Lactobacillus plantarum_ GKM3, _Bifidobacterium bifidum_ GKB2, and _Lactobacillus paracasei_ GK56. Results showed an important improvement in Eczema Area and Severity Index (EASI) without any adverse effects.