# Role of Nutribiotics in Skin Care
## 5 Nutribiotics: An Opportunity to Improve Skin Health
### Other Uses of Nuttibiotics  
One of the main issues in skin care is the maintenance of skin barrier and hydration. A double-blind trial involving combinations of probiotics and prebiotics (_B. breve_ strain Yakult + galactooligosaccharides) supplemented with fermented milk (100 mL/day for 4 weeks) resulted in the maintenance of an optimal level of skin hydration, a decrease in the activity of cathepsin L-type endopeptidase and the phenol content in serum and urine, exerting beneficial effects on both the intestine and the skin [171]. Additionally, a trial with _L. casei_ (1 \(\times\) 1011 bacteria/day for 8 weeks) conducted by [PERSON] et al. [185] demonstrated a significant reduction in TEWL (trans-epidermal water loss) and skin flakiness [172]. Furthermore, the oral administration of heat-killed _L. lactis_ (60 mg/day for 8 weeks) significantly modulated various skin properties, such as skin elasticity, melanin content, and sebum content, with a notable effect in the younger age groups. And a para-probiotic prepared from Kimchi-derived _Lactobacillus plantarum_ K8 improved the skin hydration in human keratinocyte [256]. Taking into account that skin immune conditions, such as acne, rosacea, and atopy, are associated with skin barrier disruption and that the restoration of this barrier is associated with an amelioration of the conditions [257], the topical application of probiotics is also considered. For example, [PERSON] et al. [258] found _Lactobacillus paracasei_ CNCM I-2116 (ST11) to inhibit P-substance-induced skin inflammation and accelerate the regeneration, contributing to epidermal barrier repairment; finding that significantly eliminates all the effects of P-substance, including vasodilatation, edema, mast cell degranulation, and TNF-\(\alpha\) release compared to the controls. Moreover, the ST11-associated skin barrier recovery was found to be accelerated in an ex vivo skin culture [258]. In a review performed by [PERSON] et al. [144] related to the immune modulation properties of _Lactobacillus paracasei_ NCC2461 (ST11) strain, the authors concluded that this strain contributes to the reinforcement of the skin barrier function and modulates the skin's immune system, reducing skin sensitivity, which leads to an improvement in defenses and the preservation of skin homeostasis. Melasma could be also a target for nutribiotics. [PERSON] et al. [173] performed an experimental study employing a prospective, double-blind, randomized controlled trial in patients suffering from facial melanoma. Participants were randomly treated with oral synbiotics or placebo, one sachet daily for 12 weeks; melanoma severity and skin health were evaluated at baseline at weeks 4, 8, and 12. Synbiotics consisted of a combination of 50 billion CFUs of six probiotics strains: _Lactobacillus acidophilus_, _Lactococcus lactis_, _Lactobacillus casei_, _Bifidobacterium bifidum_, _Bifidobacterium longum_, and _Bifidobacterium infantis_, with prebiotic fructo-oligosaccharide, skim milk powder, lactose, maltodextrin, and citric acid. The results showed that the melasma score in the synbiotics supplement group was significantly lower than that in the placebo group [173]. Regarding the use of probiotics in systemic lupus erythematosus (SLE), a systematic review performed by [PERSON] et al. [259] identified 22 articles examining the effects of probiotics on SLE. These studies, which include in vivo tests, in vitro research, and clinical trials, indicated that probiotics may be effective against inflammation, improving immunological responses as well as the metabolic profiles in SLE patients. The main strains were _Lactobacillus delbrueckii_ and _Lactobacillus rhamnosus_[260, 261, 262, 263]; a mixture of _Lactobacillus rhamnosus_, _Lactobacillus reuteri_, _Lactobacillus jolnsonii_, _Lactobacillus oris_, and _Lactobacillus gasseri_[264]; and _Lactobacillus plantarum_[265]. In a double-blind randomized clinical trial, [PERSON] et al. [174] investigated the effect of a symbiotic formula comprising _L. helicus_, _B. infantits_, _B.