Prospective placebo-controlled assessment of spore-based probiotic supplementation on sebum production, skin barrier function, and acne

Authors: RYBAK, IRYNA - University Of California, Davis; HAAS, KELLY - University Of California, Davis; DHALIWAL, SIMRAN - University Of California, Davis; BURNEY, WAQAS - University Of California, Davis; POURANG, AUNNA - University Of California, Davis; SANDHU, SIMRAN - University Of California, Davis; MALOH, JESSICA - Wayne State University; Newman, John; CRAWFORD, ROBERT - California State University; SIVAMANI, RAKA - University Of California, Davis

Submitted to: Journal of Clinical Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/20/2023
Publication Date: 1/23/2023
Citation: Rybak, I., Haas, K., Dhaliwal, S., Burney, W., Pourang, A., Sandhu, S.S., Maloh, J., Newman, J.W., Crawford, R., Sivamani, R.K. 2023. Prospective placebo-controlled assessment of spore-based probiotic supplementation on sebum production, skin barrier function, and acne. Journal of Clinical Medicine. 12(3). Article 895. https://doi.org/10.3390/jcm12030895.
DOI: https://doi.org/10.3390/jcm12030895

Interpretive Summary: Antibiotic therapy is widely used to treat various dermatological conditions. However, such widespread use can lead to antibiotic resistance that can affect the gut microbiome. Probiotic supplementation can be an alternative approach in modulating the gut microbiome and may have direct beneficial effects in treatments of atopic dermatitis and acne. This double-blinded, 8-week study was designed to assess how oral probiotics alter skin biophysical properties and sebum production, while evaluating secondary impacts on the gut microbiome and markers of microbiome changes including gut permeability and plasma short chain fatty acids. Twenty-five healthy participants, some with non-cystic acne, were assigned to take placebo pills for the first four weeks, followed by four weeks of probiotic intake. Blood and gut collection, facial photography, facial sebum production, transepidermal water loss (TEWL), and hydration measurements were performed at baseline, 4- and 8-weeks. A board-certified dermatologist blinded to study interventions, graded the inflammatory and non-inflammatory lesions in subjects with acne. The skin biophysical properties were marginally effected after probiotic supplementation, with a tendency to decrease sebum excretion and increased TEWL overall. A subset analysis of those with non-cystic acne showed improvement in total, non-inflammatory, and inflammatory lesion counts. Both bacterial derived lypopolysacharides and fatty acid binding protein-2, markers of gut permeability, had improving trends after probiotic supplementation in the acne subgroup. The non-acne population had a shift in the gut microbiota with an increase relative abundance of Akkermansia, while the acne population had an increase in the relative abundance of Lachnospiraceae and [Ruminococcus] gnavus. Overall, short chain fatty acid analysis revealed an augmentation of the circulating acetate:propionate ratio. These results offer preliminary evidence for the use of spore-based probiotic supplementation to shift the gut microbiome in those with and without acne. Future studies will be needed to better understand the role of probiotics in sebum production and in modulating acne.

Technical Abstract: Previous studies have suggested that probiotic supplementation modulates the gut-skin axis. This study assesses if oral spore-based supplementation affects the gut microbiome, plasma short chain fatty acids, and the biophysical properties of the skin. This was a double-blinded, 8- week study (NCT03605108) in which 25 participants, 7 with non-cystic acne, were assigned to take placebo pills for the first four weeks, followed by four weeks of probiotic intake. Blood and gut collection, facial photography, sebum production, transepidermal water loss (TEWL), hydration measurements, and acne assessments were performed at baseline, 4- and 8-weeks. Probiotic supplementation led to a trend in decreased sebum excretion and increased TEWL overall. Subanalysis in acne showed improvement in total, non-inflammatory, and inflammatory lesion counts along with improvements in markers of gut permeability. The non-acne population had an increase in the gut relative abundance of Akkermansia, while the acne population had an increase in the gut relative abundance of Lachnospiraceae and [Ruminococcus] gnavus. Supplementation augmented the circulating acetate:propionate ratio. There is preliminary evidence for the use of spore-based probiotic supplementation to shift the gut microbiome and augment short chain fatty acids in those with and without acne. Further spore-based supplementation studies in those with non-cystic acne are warranted.