Probiotics in the Treatment of Thrush, Cystic Acne, and Atopic Dermatitis

Probiotics are defined as “live microorganisms which, when administered in adequate amounts, confer a health benefit to the host.”1

There has been an increasing interest in using probiotics to prevent Clostridium difficile in patients being treated with antibiotics.  I have personally written a blog post titled Probiotics, Gut-Brain Axis and Psychiatry.  There are a number of benefits one may gain from taking probiotics.  In this post, I will concentrate on oral thrush, acne, and atopic dermatitis.  More topics will be covered in future articles. 

 

Probiotics for Thrush

Thrush (oral candidiasis) is a fungal infection affecting the oral mucosa. This appears as white lesions on the tongue and inner cheeks. Thrush is usually caused by Candida albicans. We have historically treated this condition with antifungal agents such as nystatin, miconazole, or fluconazole. These medications may cause unwanted side effects such as nausea, vomiting, and diarrhea. Candida may also become resistant to these antifungal agents, and for this reason, it is prudent to search for new methods for the prevention and treatment of oral thrush.

Probiotics have been studied for the treatment of thrush. A systemic review and meta-analysis by Hu, et al. was published in July of 2019.

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These researchers concluded that probiotics were significantly superior to placebo in the prevention and treatment of oral candidiasis. This was true both in clinical trials of elderly patients, denture wearers, and animal experiments. Probiotics inhibited colonization of Candida on the oral mucosa and decreased the clinical signs and symptoms of the fungal infection.

Although this is very promising, more studies are needed to compare the effectiveness of probiotics to traditional antifungal treatments in the treatment of oral thrush.

Probiotics for Cystic Acne

Acne is a common nuisance for those in their teenage years. This skin condition occurs when skin pores get clogged with skin cells and other substances. At times, bacteria can become trapped inside the pore, causing the surrounding area to become red and swollen. This area is known as a “pimple.”  

It is estimated that 85-90% of the population may be affected by acne in countries eating western diets.  Some dermatologists actually consider acne to be a normal development process.

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If this bacterial infection penetrates deep into the skin, large, red, tender pimples can form, which are full of pus. When these pus pockets burst, the infection may spread, causing an increased number of pimples, which can also be called “cysts.” This condition is known as cystic acne.

If cystic acne is left untreated, it may lead to scarring.  

We are still unsure of the exact cause of this condition. Androgens in males play a part, and the hormonal changes in females, due to menopause, pregnancy, or polycystic ovarian syndrome may also be involved.

The usual over-the-counter acne products containing benzoyl peroxide often have little effect on cystic acne. Dermatologists may prescribe the following treatments.

  • Spironolactone: This is a “water pill” used for hypertension by eliminating excess water from the body. It has also been shown to be effective for the treatment of acne in women.4
  • Antibiotics: These can help control the bacteria leading to a decrease in inflammation. Minocycline is often used.
  • Accutane: This is available by prescription only. This medication must not be used by women who are, or may become, pregnant.
  • Steroid injections may be performed at your physician’s office. These medications are injected directly into the cysts.
  • Prescription topical products containing retinoids can help unplug skin pores.

There is evidence that probiotics may be useful in the treatment of acne. The formation of acne is dependent on:

  • Follicular hyperkeratinization
  • Excess production of sebum
  • Propiobacterium acnes colonization
  • The inflammatory cascade
5

Fifty-four percent of patients with acne vulgaris have marked alterations in their intestinal flora. 6

Probiotics may help treat acne in several ways:

They reduce inflammation present in patients with acne.7

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Probiotics may decrease the amount of sebum present, which lessens the colonization of P. acnes. 9

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They may also work indirectly by decreasing side effects caused by other acne treatments.

Studies have been done to access the effects of probiotics in the treatment of acne.  John Stokes and Donald Pillsbury, both dermatologists, believed depression, anxiety, and skin conditions, such as acne, could be improved by ingesting Lactobacillus acidophilus cultures.  This was their belief nearly eighty years ago.

In 1961, Robert Siver, a physician from Baltimore, followed 300 patients who were given L. acidophilusan and L. bulgaricus tablets.  His report claimed 80% of these patients who had acne showed clinical improvement.  He also observed the probiotics were more helpful in those with inflammatory acne.  Although this was not a placebo-controlled study, it seems to suggest probiotics can be useful in the treatment of acne. 11

More recently, a review was published in the International Journal of Dermatology highlighting several studies regarding the use of probiotics in the treatment of acne.  These studies consisted of topical as well as systemic treatments.

A study was conducted on acne patients between the ages of 18 and 30 years of age investigating the effectiveness of daily ingestion of fermented milk enriched with 200 mg of lactoferrin for 12 weeks.  The lactoferrin group showed 38.6% less inflammatory acne lesion compared to placebo. 12

Probiotics for Atopic Dermatitis

Atopic dermatitis (AD) usually develops at a young age and is characterized by red, dry, scaly, itchy skin.  This is more common in people who are related to others with the condition.  It is estimated that between 1-20% of the world’s population is affected by AD.13

It is believed that Atopic dermatitis is the result of a genetic condition which leads to disruption of the epidermis of the skin. 14

Studies indicate that this condition is caused by both skin barrier dysfunction as well as an improper immunologic response.

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Initial treatment of AD consists of body moisturizers and the adoption of habits that reduce dry skin.  If infection is present, antibiotics can be indicated, specifically those effective against Staphylococcus and Streptococcus species. 17

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As with acne, the alteration of intestinal and skin micro flora is a possible therapeutic target to explore.  It is certain that treating these conditions with antibiotics alters the skin biome, gut biome, or both depending on the route utilized.  This may lead to a decrease in the beneficial effects of a healthy micro biome.19

It is not known whether the skin biology conditions lead to the increase in skin flora, or if excess growth of Staphylococcus occurs first, leading to the progression of AD. 20

Many studies examining the use of both topical and systemic probiotic preparations in the treatment of atopic dermatitis were outlined in the review article by Mottin, et al in the International Journal of Dermatology. 21

The use of probiotics to treat various health conditions has been a popular subject of late.  There are so many possible uses that I must write several posts to cover them all.  This is my second post covering probiotics.

 Click here to read about probiotics, the gut-brain axis, and psychiatry.   

There is growing evidence that probiotics can be beneficial for oral thrush, acne, and atopic dermatitis.

As a pharmacist, I am well aware of the side effects produced by prescription medications.  Creams used to treat skin conditions such as acne can cause the skin to become dry.  We have all heard about the problems with antibiotics.  Although necessary in some situations, antibiotic use invariably leads to bacterial resistance.  The other fear is that the antibiotics will kill the “good” bacteria present in our bodies, throwing off the micro biome of the gut and skin.  Not only can this make the skin conditions described in this post worse, but it also can be a cause of oral thrush. 

I believe probiotics will be used more extensively as new research becomes available.  It is important to note that although these products are safe for most, caution is advised when using probiotics in immunodeficient patients or those currently using immunosuppressants.  These patients are more prone to infections.

 

As always, contact us with any questions.  We are always here to help.

Be happy and healthy!!!!!

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.

 

 
  1. Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B, Morelli L, Canani RB, Flint HJ, Salminen S, Calder PC, Sanders ME Nat Rev Gastroenterol Hepatol. 2014 Aug; 11(8):506-14.

  2. Hu L, Zhou M, Young A, Zhao W, Yan Z. In vivo effectiveness and safety of probiotics on prophylaxis and treatment of oral candidiasis: a systematic review and meta-analysis. BMC Oral Health. 2019 Jul 10;19(1):140. doi: 10.1186/s12903-019-0841-2. PubMed PMID: 31291932; PubMed Central PMCID: PMC6621984.

  3. Danby FW. The three acnes and their impact. In: Danby FW, Acne: Causes and Practical Management. Chichester, UK: John Wiley & Sons Ltd, 2014: 1–30.

  4. Plovanich M, Weng QY, Mostaghimi A. Low Usefulness of Potassium Monitoring Among Healthy Young Women Taking Spironolactone for Acne. JAMA Dermatol. 2015 Sep;151(9):941-4. doi:10.1001/jamadermatol.2015.34. PubMed PMID: 25796182.
  5. Baquerizo Nole K.L., Yim E., Keri J. Probiotics and prebiotics in dermatology. J Am Acad Dermatol. 2014;71:814–821.

  6. Volkova L.A., Khalif I.L., and Kabanova I.N.: Impact of the impaired intestinal microflora on the course of acne vulgaris [in Russian]. Klin Med (Mosk) 2001; 79: pp. 39-41.

  7. Muizzuddin N., Maher W., Sullivan M., Schnittger S., and Mammone T.: Physiological effect of a probiotic on skin. J Cosmet Sci 2012; 63: pp. 385-395.

  8. Kang B.S., Seo J.G., Lee G.S., Kim J.H., Kim S.Y., Han Y.W., et al: Antimicrobial activity of enterocins from . J Microbiol 2009; 47: pp. 101-109.

  9. Yamamoto A., Takenouchi K., and Ito M.: Impaired water barrier function in acne vulgaris. Arch Dermatol Res 1995; 287: pp. 214-218.

  10. Kim J., Ko Y., Park Y.K., Kim N.I., Ha W.K., and Cho Y.: Dietary effect of lactoferrin-enriched fermented milk on skin surface lipid and clinical improvement of acne vulgaris. Nutrition 2010; 26: pp. 902-909.

  11. Siver RH. Lactobacillus for the control of acne. J Med Soc New Jersey. 1961;59:52–53.

  12. Kim J, Ko Y, Park YK, et al. Dietary effect of lactoferrinenriched fermented milk on skin surface lipid and clinical improvement of acne vulgaris. Nutrition 2010; 26: 902–909.

  13. DaVeiga SP. Epidemiology of atopic dermatitis: a review. Allergy Asthma Proc 2012; 33: 227–234.

  14. Berke R, Singh A, Guralnick M. Atopic dermatitis: an overview. Am Fam Physician 2012; 86: 35–42.

  15. Sugarman JL. The epidermal barrier in atopic dermatitis. Semin Cutan Med Surg 2008; 27: 108–114.

  16. Novak N, Bieber T, Leung DY. Immune mechanisms leading to atopic dermatitis. J Allergy Clin Immunol 2003; 112: S128–S139.

  17. Berke R, Singh A, Guralnick M. Atopic dermatitis: an overview. Am Fam Physician 2012; 86: 35–42.

  18. Eichenfield LF, Tom WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: Section 2. Management and treatment of atopic dermatites with topical therapies. J Am Acad Dermatol 2014; 72: 116–132.

  19. Schommer NN, Gallo RL. Structure and function of the human skin microbiome. Trends Microbiol 2013; 21: 660–668.

  20. Sanford JA, Gallo RL. Functions of the skin microbiota in health and disease. Semin Immunol 2013; 25: 370–377.

  21. Mottin VHM, Suyenaga ES. An approach on the potential use of probiotics in the treatment of skin conditions: acne and atopic dermatitis. Int J Dermatol. 2018 Dec;57(12):1425-1432. doi: 10.1111/ijd.13972. Epub 2018 Apr 20. Review. PubMed PMID: 29676446.

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