- The Effectiveness of Probiotic in the Treatment of Inflamed Acne
Background: Acne Vulgaris is the most common skin disease in adults. Prolonged use of oral antibiotic in inflamed acne can destroy the beneficial microorganisms causing other diseases. Probiotic can reduce inflammatory mediators by improving the gut dysbiosis, decrease IGF-1 level which is involved in follicular hyperkeratinization and also decrease substance P level effecting on sebocytes and sebum production. In combination with topical regimens, probiotic can be favorable in acne treatments and are concurrently beneficial to the gut.
Objectives: To evaluate the effectiveness of probiotic in the treatment of inflamed and non-inflamed acne. Materials and Methods: The prospective, experimental study follows the double-blinded, randomized controlled trial. Thirty female patients , aged between 20-40 years old, with mild to moderate acne vulgaris were enrolled. All participants were divided equally into two groups and randomly assigned either probiotics (100 × 109 CFUs/day) or placebo to be taken for 12 weeks. Both groups were received topical 2.5% benzoyl peroxide and 1% clindamycin lotion applied twice daily. TS6 probiotic is synbiotic which contains 6 species (Lactobacillus acidophilus, Lactobacillus casei, Bifidobacterium longum, Bifidobacterium infantis, Bifidobacterium bifigum, Lactococcus lactis ) and one prebiotic (Oligosaccharide). Inflamed lesion counts, comedones and total lesion counts were evaluated at 0, 2, 4, 8, and 12 weeks. The sebum at forehead, both cheeks and chin were assessed by Sebumeter at 0, 12 weeks. Post-acne redness (PAR) were estimated by Mexameter MX18 at 0, 12 weeks. The Statistical analysis within group used pair T-test whereas in between groups using T-test.
Results: Twenty-five patients completed the study. Mean age of thirteen participants in the probiotic was 29.2 ± 4.0 year. Mean age of the twelve participants in the placebo group was 27.8 ± 4.5 years. Both of the probiotic group and the placebo group showed significant decrease in inflamed lesion counts at 2nd week ( p < 0.01 and p < 0.05), significant comedones depletion at 8th week ( p < 0.01 and p < 0.05), and significant improvement in total lesion counts at 4th week ( p < 0.01 and p < 0.05) with no difference between two groups in inflamed lesion counts, comedones and total lesion counts. This acne improvement may come from topical 2.5% benzoyl peroxide and 1% clindamycin lotion. Percentage reduction of inflamed lesion counts in the probiotic group was higher than in the placebo group in any visits. ( at 2nd week were 35.3% and 28.6%, at 4th week were 47.1% and 35.7%, at 8th week were 70.6% and 50%, and at 12th week were 76.5% and 64.3%, respectively). Comedones in the placebo group increased in first 2 weeks (2.6%) and gradually decreased by week 4 to week 12, whereas comedones in the probiotic groups have reduced in every weeks since the beginning. Percentage reduction of comedones in the probiotic group was higher than in the placebo group in any visits ( at 2nd week were 8.3% and -2.6%, at 4th week were 14.6% and 10.3%, at 8th week were 33.3% and 23.1%, and at 12th week were 50% and 41%, respectively). Percentage reduction of total lesion counts in the probiotic group was higher than in the placebo group in any visits (at 2nd week were 15.4% and 3.8%, at 4th week were 23.1% and 17.3%, at 8th week were 43.1% and 28.8%, and at 12th week were 58.5% and 46.2%, respectively). Implying that probiotic can augmenting the acne treatment, but still have no statistical significant.
At 12th week, sebum score of all forehead, both cheeks and chin areas in the probiotic group were reduced, though insignificantly. Probiotic probably showed benefits on sebum production, but have to extend the course of treatment to prove the significant results. At 12th week, the erythema index of the PAR in both groups reduced significantly ( p < 0.01, p < 0.01) with no difference between two groups. So that probiotic have no benefit on the PAR compared to the control group. Five participants (38.5%) in the probiotic group experienced an increased in the frequency of defecation. No participants complaint about any side effects after probioticadministration.
Conclusion: The treatment of mild to moderate acne by supplementing probiotics with the standard topical regimens have no significant difference in inflamed lesion counts, comedones and total lesion counts comparing to the topical treatment only. But percent reduction of inflamed lesion counts, comedones and total lesion counts in the probiotic group were higher than the control group in every visits. However, further studies including the duration of treatment, an appropriate amount of probiotic per day or the specific microorganisms of probiotic should be conducted.
Keywords: probiotics, acne vulgaris, inflamed acne, comedoes
2001-2007: Doctor of Medicine (second class honors), Ramathibodi Hospital
2011-2012: Diploma in Dermatology and Dermatosurgery, Institute of Dermatology
2016-2018: Master’s Degree of Anti-Aging and Regenerative Medicine, Dhurakij Pundit University
2008-2011: General practice, Department of Family Medicine, Ramathibodi Hospital
2010-2018: Aesthetic doctor at Dermcare Clinic and Immagini Clinic