Wageningen 

Academic 
Beneficial Microbes, 2014; 5(2): 99-107 P u b l i s h e r s

Impact of prebiotics and probiotics on skin health

http://www.wageningenacademic.com/doi/pdf/10.3920/BM2013.0040 - Thursday, September 21, 2017 1:35:57 AM - Göteborgs Universitet IP Address:130.241.16.16

F.H. Al-Ghazzewi and R.F. Tester

Glycologic Limited, 70 Cowcaddens Road, Glasgow, G4 0BA, United Kingdom; f.h.alghazzewi@glycologic.co.uk

Received: 24 September 2013 / Accepted: 8 December 2013

© 2014 Wageningen Academic Publishers

REVIEW ARTICLE
Abstract

This review discusses the role of pre- and probiotics with respect to improving skin health by modulating the
cutaneous microbiota. The skin ecosystem is a complex environment covered with a diverse microbiota community.
These are classified as either transient or resident, where some are considered as beneficial, some essentially neutral
and others pathogenic or at least have the capacity to be pathogenic. Colonisation varies between different parts of
the body due to different environmental factors. Pre- and probiotic beneficial effects can be delivered topically or
systemically (by ingestion). The pre- and probiotics have the capacity to optimise, maintain and restore the microbiota
of the skin in different ways. Topical applications of probiotic bacteria have a direct effect at the site of application
by enhancing the skin natural defence barriers. Probiotics as well as resident bacteria can produce antimicrobial
peptides that benefit cutaneous immune responses and eliminate pathogens. In cosmetic formulations, prebiotics
can be applied to the skin microbiota directly and increase selectively the activity and growth of beneficial ‘normal’
skin microbiota. Little is known about the efficacy of topically applied prebiotics. Nutritional products containing
prebiotics and/or probiotics have a positive effect on skin by modulating the immune system and by providing
therapeutic benefits for atopic diseases. This review underlines the potential use of pre- and probiotics for skin health.

Keywords: prebiotic, probiotic, synbiotic, skin microbiota, skin health

1. Introduction redefined the concept as ‘A live microbial feed supplement

Recently, attention has grown regarding the use of pre- and
probiotics in the cosmetic fields. Firstly, to manipulate
the compositional and/or functional properties of
skin microbiota. Secondly, to contribute towards skin
regeneration and blemish/wound healing. This review
discusses the role of pre- and probiotics in cosmetic
products and the associated scientific underpinning.
Body friendly bacteria – ‘probiotics’
The term probiotic means ‘for life’ and it is used to name
microorganisms associated with beneficial effects in
humans and animals (FAO/WHO, 2001). A number of
definitions have been proposed for this concept, going back
to 1907, when the Russian immunologist Eli Metchnikoff
defined it as ‘The dependence of the intestinal microbes
on the food makes it possible to adopt measures to modify
the flora in our bodies and to replace the harmful microbes
by useful microbes’ (Metchnikoff, 1907). Fuller (1989)
which beneficially affects the host animal by improving
its intestinal balance’. Havenaar and Huis in’t Veld (1992)
proposed a similar definition as ‘a viable mono or mixed
culture of bacteria which, when applied to animals or man,
beneficially affects the host by improving the properties
of the indigenous flora’. A commonly cited definition is
‘live microorganisms, which when consumed in adequate
amounts, confer a health effect on the host’ (FAO/WHO,
2001). Probiotic bacteria strains belonging to the genera
Bifidobacterium and Lactobacillus are the most common
probiotics, although other species from other bacterial
genera such as Bacillus, Enterococcus and Streptococcus,
in addition to the yeast Saccharomyces, have also been
classified as probiotics (Boyle et al., 2011).
Probiotic efficacy is concerned traditionally with the gut of
the host (especially colon). In terms of applications to the
skin, the beneficial effect can be achieved (1) by ingesting
the live microorganisms (Levkovick et al., 2013) or (2) by
topical applications (Di Marzio et al., 2008; Farmer and

ISSN 1876-2833 print, ISSN 1876-2891 online, DOI 10.3920/BM2013.004099

 F.H. Al-Ghazzewi and R.F. Tester
Mikhail, 1998; Krutmann, 2009; Volz and Biedermann,
2009). Probiotics have the capacity to optimise, maintain
and restore the microbiota of the skin in different ways.
However, the application of live probiotics to the skin
creates many challenges (Tester and Al-Ghazzewi, 2012).
These relate to ensuring the viability of probiotic bacteria
http://www.wageningenacademic.com/doi/pdf/10.3920/BM2013.0040 - Thursday, September 21, 2017 1:35:57 AM - Göteborgs Universitet IP Address:130.241.16.16
and being able to recolonise the skin after the addition
of new microbiota, which may themselves be a harsh
environment.
Selective nutrition for probiotics – ‘prebiotics’
In contrast to probiotics, a prebiotic is defined according
to the classical view of Gibson and Roberfroid (1995) and
Roberfroid (2007) as ‘a selectively fermented ingredient
that allows specific changes, both in the composition
and/or activity in the gastrointestinal microflora that
confers benefits upon host well-being and health’. The
term prebiotic was developed initially to describe materials
(carbohydrates) which travel to the colon when ingested
and therein promote the growth of desirable (probiotic)
organisms. Examples include: fructooligosaccharides (FOS),
galactooligosaccharides, glucomannan oligosaccharides,
inulin, isomalto-oligosaccharides, lactosucrose,
lactulose, neosugars, palatinose, raffinose, sorbitol, soy
oligosaccharides, xylitol and xylooligosaccharides (Al-
Ghazzewi et al., 2007; Connolly et al., 2010; Roberfroid,
2007; Tomasik and Tomasik, 2003; Van Loo et al.,
1999). In cosmetic formulations, the term prebiotic can
be applied ‘in principle’ to the skin microbiota where
the carbohydrates stimulate selectively the activity and
growth of beneficial ‘normal’ skin microbiota (Krutmann,
2009). Some carbohydrates, e.g. konjac glucomannan,
fructooligosaccharides, are capable of promoting skin health
in unique ways, especially the glucomannans (Al-Ghazzewi
and Tester, 2010; Bateni et al., 2013).
Synbiotics
Both probiotics and prebiotics complement each other when
used to improve health. A combination of the two concepts
is called synbiotic (Fooks and Gibson, 2002; Gibson and
Roberfroid, 1995), where substrates can increase the
survival of the probiotic strains. Su et al. (2007) found that
prebiotics enhance the survival and prolong the retention
period of specific probiotics by treating mice with soybean
oligosaccharide (SOS), FOS or inulin, followed by probiotics
Lactobacillus acidophilus LAFTI L10 (L10), Bifidobacterium
lactis LAFTI B94 (B94) or Lactobacillus casei L26 LAFTI
(L26). Synbiotics have the capacity to optimise, maintain
and restore the microbiota of the skin systemically or
by topical applications (Figure 1). One major problem
with topical applications of probiotics, even in synbiotic
formulations, is the harsh environmental conditions of the
skin, which prevent colonisation (Bojar and Holland, 2002),
100
Prebiotics
Act as nutrient
sources
Probiotics
Topical
applications Ingestion
Unbalanced skin microbiota
P. acnes > S. epidermidis
Promote the growth of Gastrointestinal
beneficial microbiota at tract
the expense of harmful
microbiota
Systemic
Balanced skin microbiota effects
S. epidermidis > P. acnes
Help prevent skin
diseases
Figure 1. Role of pre- and probiotics for skin care.
although this is not the case in other areas of the body, such
as the oral and vaginal cavities (Tester and Al-Ghazzewi,
2013). Synbiotics have been claimed to have beneficial
effects in the treatment and prevention of gastrointestinal
diseases (Ritchie and Romanuk, 2012). However, reports
suggest the function extends beyond the gut by inducing
systemic effects on the skin (Ouwehand et al., 2002; Suzuki
et al., 2010). This has been discussed elsewhere in terms of
the gut-associated lymphoid tissue system (Saavedra and
Tschernia, 2002).
2. Skin ecosystem
Human skin is covered with a diverse multicellular
community of microorganisms (Grice and Segre, 2011).
These microbiota comprise bacteria and fungi in a
diverse topography with typical counts of 10 2 to 107
cells/cm2 reflecting their different niches (Findley et al.,
2013; Fredricks, 2001; Grice and Segre, 2011; Human
Microbiome Project Consortium, 2012). Normal skin
microbiota are classified (Figure 2) as either ‘resident’ (i.e.
adhering predominantly to the skin, maintaining viability
and reproducibility) or ‘transient’ (i.e. deposited but do
not adhere to the surface of the skin, with little or no
sustained growth and reproduction) (Noble, 1981). The skin
ecosystem is a complex environment due to the physical
structure of the skin and the environmental factors it is
exposed to; hence (in the healthy state) it tends to resist
microbial colonisation (Bojar and Holland, 2002). In skin
care, exposure of the skin to rapidly changing external
influences has a profound effect on the microbiological
ecology. Influences from within the body, including diet
Beneficial Microbes 5(2)
  Impact of prebiotics and probiotics on skin health

(Propionibacterium acnes, Propionibacterium avidum

Yeast and Propionibacterium granulosum), coagulase-negative
Malassezia
furfur staphylococci (Staphylococcus epidermidis), micrococci,
corynebacteria, brevibacteria, Acinetobacter and the
yeast species Malassezia with some bacteriophages. Most
Gram +ve cocci Gram –ve bacilli
Micrococci (mostly): Acinetobacter common transient species are Staphylococcus aureus,
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M. luteus Streptococcus pyogenes, Escherichia coli and Pseudomonas

aeruginosa (Fredricks, 2001; Krutmann, 2009; Leyden et
al., 1987) as shown in Figure 2.
Gram +ve bacilli Gram +ve cocci
Propionibacterium (e.g. Staphylococci
P. acnes, P. avidium, (mostly): The number of microbial species on skin vary according
P. granulosum) S. epidermidis to the parts of the body and type of microflora (Kong
Corynebacterium S. haemolyticus
Brevibacterium S. hominis and Segre, 2012; Tester and Al-Ghazzewi, 2012). In
Dermatobacter
wet skin areas, aerobic bacteria counts range from 102
to 107 cells/cm2, while the anaerobic counts range from
Resident microbiota 104 to 106 cells/cm2 (Leyden et al., 1983; Noble, 1981).
Propionibacterium and Staphylococcus species are the most
Transient microbiota abundant in sebaceous sites, while Corynebacterium and
Staphylococcus species predominate in moist sites. In dry
sites, a mixed bacterial population seems to reside (Grice
Deposited on the skin
e.g. Staphylococcus aureus et al., 2008, 2009). Gao and colleagues (2010) quantified
Streptococcus pyogenes Propionibacterium, Corynebacterium, Streptococcus,
Pseudomonas aeruginosa
Bacillus Staphylococcus and Malassezia in six body locations
Escherichia coli (forehead, axillae, inner elbows, forearms, forelegs and
behind ears) of eight healthy subjects using real-time PCR.
The authors found that the highest counts of bacteria were
Figure 2. Normal skin microbiota composed of resident and in the axilla, while the forearm had the lowest counts.
transient microorganisms. Streptococcus was the most common bacterium on the
forehead and behind the ear, while Corynebacterium spp.
were predominant in the axilla. Malassezia spp. were
and hormones, have a considerable impact on the skin too found with only very low counts. Costello et al. (2009)
(Al-Ghazzewi and Tester, 2010). Stability is maintained reported that body sites across individuals, such as the
by interactions between different microbial species and palm and forearm, exhibited high microbial diversity,
between the host and microbiota. Microorganisms in this while other sights like the forehead showed less. This is
ecosystem are considered to be beneficial, some essentially due to the fact that the hands are the most frequent parts
neutral and some pathogenic (or have the capacity to be with which people touch various surfaces and various
pathogenic). Little has been done to optimise the favourable microorganisms persist on inanimate surfaces (Kramer et
ecology of the skin, which is a poorly understood area al., 2006). However, the forehead has a different ecology.
(Tester and Al-Ghazzewi, 2012). It is a lipid rich environment and thus may favour the
colonisation of P. acnes (convert triglycerides to free fatty
3. Skin microbiota acids), hence inhibiting other microorganisms, (Gribbon
et al., 1993; Shu et al., 2013; Thormar and Hilmarsson,
Exposure to hostile skin conditions on a frequent basis 2007) including S. aureus (Shu et al., 2013). Colonisation
means only a limited number of microbial types can of microbiota can also vary in association with progressive
colonise effectively. This actual colonisation varies sexual maturation. Oh et al. (2012) characterised and
between different parts of the body and is encouraged by compared the bacterial communities of four body sites
the presence of large amounts of water, proteins, lipids including skin parts for 28 healthy subjects aged 2 to 40
and where a little evaporation of water occurs (Leyden years. The authors found that Firmicutes (Streptococcaceae),
et al., 1987). All these factors are influenced by the Bacteroidetes and Proteobacteria were abundant in children,
environmental exposure of the body and bathing profiles, while Corynebacteriaceae and Propionibacteriaceae
and the constant association with clothes, age, genetic predominated in adults. For further details on the microbial
makeup and immune response play a role on colonisation community composition and diversity of skin microbiome
(Kong and Segre, 2012; Murillo and Raoult, 2013; Tester and its dynamics following skin barrier disruption, the
and Al-Ghazzewi, 2012). The types of microbes on the reader is referred to Zeeuwen et al. (2012).
skin include the resident species of propionibacteria

Beneficial Microbes 5(2) 101

 F.H. Al-Ghazzewi and R.F. Tester

4. Pre- and probiotics for health a direct immunomodulatory effect on skin-associated

Ingested probiotics (e.g. Lactobacillus bulgaricus,
Lactobacillus plantarum, Lactobacillus casei) have
been shown to reduce acne symptoms by inhibiting the
production of pro-inflammatory cytokines (Chiba et al.,
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immune responses (Guéniche et al., 2008c). In addition,
Guéniche and colleagues (2010a) have reported the effect
of cream containing Bifidobacterium longum extract on
reactive skin. The authors found that subjects that applied
the cream had a significant decrease in skin sensitivity and

2010; Chon et al., 2010; Paszti-Gere et al., 2012), which
seem to act as mediators for the initiation of acne lesions
(Zouboulis et al., 2005). A number of studies have reported
on the therapeutic effects of probiotics on atopic dermatitis
(Betsi et al., 2008; Meneghin et al., 2012; Weston et al.,
2005; Yesilova et al., 2012). The assumption for efficacy is
that these beneficial effects occur systemically, by which
the probiotic microorganisms exert specific effects in the
intestinal lumen and on epithelial cells and immune cells
with antiallergic potential (Caramia et al., 2008). Apparently,
the approach may induce a ‘glow of health’ as claimed by
Levkovick et al. (2013). In a randomised double blind
placebo-controlled clinical trial, Guéniche et al. (2009a)
reported that certain probiotics, such as Lactobacillus
johnsonii NCC 533 (La1), can modulate skin immune
systems leading to preservation of skin homeostasis
(Guéniche et al., 2006a, 2008a; Peguet-Navarro et al., 2008).
Topical applications of probiotics have been reported
(Farmer and Mikhail, 1998) to have a very direct effect
at the site of application, by inducing natural defence
mechanisms (Volz and Biedermann, 2009). A number
of studies have reported the beneficial effects of topical
applications of Vitreoscilla filiformis on patients with
seborrhoeic dermatitis and atopic eczema (Guéniche et
al., 2006b, 2008b). Although the specific mechanism of
beneficial effects of the non-pathogenic Gram-negative
bacterium on such diseases is not yet established, it may
be due to a reduction of S. aureus counts and possibly
increase in skin resistance against physical and chemical
aggression. Furthermore, the number of repeated tape
strippings (Gao et al., 2013) required to disrupt skin barrier
function were increased in the treatment group. Thus,
some results support the hypothesis that probiotics might
exert their beneficial effect beyond the gut and to the skin
(Bowe and Logan, 2011; Guéniche et al., 2009b, 2010b;
Philippe et al., 2011).
The enhancement of skin natural defences exerted by
probiotics (Figure 3) occurs due to competition with
pathogens for nutrients, mucosal adherence, modulation
of mucosal immune functions and by production of
antimicrobial metabolites like bacteriocins (O’Sullivan et al.,
2005; Santos et al., 2003; Todoriki et al., 2001; Van Reenen
et al., 1998; Verschuere et al., 2000). Not only do probiotics
contribute towards this skin defence barrier, resident
bacteria can do so too. For example, S. epidermidis produces
antimicrobial peptides that can benefit cutaneous immune
defence systems (Cogen et al., 2008, 2010) by inhibiting
selectively S. aureus and Group A streptococci, while
maintaining normal skin microbiota (Cogen et al., 2010;
Gallo and Nakatsuji, 2011). The removal of skin resident
species, for example S. epidermidis by topical antibiotics,
will eliminate endogenous antimicrobial peptides (Bastos
et al., 2009), allowing potentially pathogenic bacteria,
such as S. aureus, to colonise the skin more effectively. As
microbial diversity varies, another positive health effect
of beneficial resident microbiota on skin is to fill niches

Prebiotics
Act as nutrient Non-preferential
sources nutrient use

(a) Bind to lectins

of pathogens
(b) Induce immune-support
Probiotics &
beneficial Growth = Inhibition
Pathogens
resident (a) Uses up the carbon source
bacteria (b) Produces acid and
(c) Other antimicrobial agents to
restrict/prevent pathogen growth
(d) Enhance immune functions

Reduce the capacity of Cause infections

infections to colonise skin Infections

Figure 3. Prebiotics stimulate the growth of probiotics and beneficial resident bacteria on skin and induce natural defence
mechanisms to inhibit the pathogens.

102 Beneficial Microbes 5(2)

  Impact of prebiotics and probiotics on skin health
that would otherwise be colonised by pathogens and
subsequently cause infection (Bojar and Holland, 2002;
Findley et al., 2013; Grice and Segre, 2011; Kong and
Segre, 2012). Propionibacteria may have beneficial effects,
such as adjuvant and anti-tumour activities. Hence these
attributes may contribute to more efficient immunological
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responses to infections (Eady and Ingham, 1994). It should
be remembered, however, that the same species are of
pathogenic relevance in for example acne and folliculitis
(Al-Ghazzewi and Tester, 2010). The pathogenicity of P.
acnes is probably due to a number of distinct phylogroups
with different phenotypes and virulences (Kwon et al.,
2013). These phylotype groups known as types IA1, IA2,
IB, IC, II and III may be associated with different types of
infections and clinical conditions (Nagy et al., 2013). Some
argue that the disease-causing potential of different P. acnes
strains is not only determined by the phylotype-specific
genome content but also by variable gene expression
(Brzuszkiewicz et al., 2011).
Prebiotics in general have been found to stimulate the
immune system in vitro and in vivo (Swanson et al., 2002;
Torrecillas et al., 2007; Yamada et al., 2003). They can
also stimulate the growth of probiotics at the expense of
pathogens, such as Salmonella typhimurium, Clostridium
perfringens, Listeria monocytogens, E. coli, S. aureus and
P. acnes (Al-Ghazzewi and Tester 2010; Al-Ghazzewi
et al., 2007, 2012, Elamir et al., 2008). Akiyama et al.
(2002) reported that glucooligosaccharides can be used
to control the growth of S. aureus, which often infects
or colonises patients with atopic dermatitis (Chase and
Armstrong, 2012). Al-Ghazzewi and Tester (2010) studied
the synbiotic effects of konjac glucomannan hydrolysates
on the growth of the skin bacterium P. acnes in vitro. The
authors concluded that the inhibition of the acne-induced
bacterium was significantly enhanced by the presence of
glucomannan hydrolysates. It is important to control the
overgrowth of some resident bacteria, such as P. acnes
on skin, and prebiotics could be a candidate for this. In a
recent study by Bateni et al. (2013), it was found that topical
formulations of konjac glucomannan hydrolysates were
able to exert a positive and direct impact on skin health,
reducing acne vulgaris in vivo and inducing a glow to skin.
The authors suggested that there is a possible link between
the glucomannan hydrolysates and sebum gland physiology.
It is possible that the hydrolysates may contribute toward
unblocking the pores on skin surface and hence restore
skin barrier properties and control superficial (and perhaps
within sebaceous glands) microbiota.
Any effects of prebiotics in the gut can be reflected in/
on other parts of the body, such as the skin, vagina or
bladder (Al-Ghazzewi and Tester, 2010; Sutherland et
al., 2008; Tester et al., 2012). Consuming prebiotics (e.g.
hydrolysed konjac glucomannan) can have a positive but
Beneficial Microbes 5(2)
indirect effect to prevent atopic diseases by suppressing
immunoglobulin E (IgE) production in mice and hence
prevent the development of dermatitis (Suzuki et al., 2010).
Although the exact mechanism of the effects of fermentable
dietary fibres on the specific immune system in the gut has
not yet been fully established, it has been suggested that
modulation of the intestinal microbiota occurs. This causes
immune-enhancing effects by lactic acid bacteria in contact
with immune cells in the intestine, the production of short
chain fatty acids (SCFAs) from the fibre degradation and/
or by changes to the mucin production (Schley and Field,
2002). Glucomannans have also been reported to modulate
skin bacterial proliferation and normalise sensitive skin
barrier functionality (Berardesca et al., 2008). Onishi et al.
(2007a) found that feeding pulverised konjac glucomannan
to mice suppressed the development of scratching
behaviour, substance ‘P’ expression with mastocytosis
and skin inflammatory immune responses. In addition,
administration of pulverised konjac glucomannan prevented
the development of allergic rhinitis-like symptoms and the
increase of plasma IgE and immunoglobulin G levels in
mice (Onishi et al., 2003, 2005, 2007b; Oomizu et al., 2006).
5. Pre- and probiotics in commercial topical
skin care products
A number of products containing prebiotics, probiotics
or synbiotics are marketed commercially by the skin
care industry. However, it seems that a limited range is
available for topical skin care products containing pre- or
probiotics at this time. These include mainly creams and
lotions formulated with either prebiotics, probiotics or
both. Some of these products claim to protect hands and
nails against bacteria. Others are designed for treating
dandruff, itching or rashes.
Prebiotics may or may not be soluble in skin care formats,
which provide many challenges. Skin care products are
alcohol- or oil-based and sometimes have a complex list
of ingredients (Tester and Al-Ghazzewi, 2012). Often,
skin products are designed to hide faults or to have a non-
selective surface kill, e.g. alcohols and salicylic acid. The
long term effects of this are not potentially conductive to
‘good skin’. In addition, skin care products are designed to
provide colour, glow, healthiness, or to treat blemishes and
cuts and/or infections. There are considerable challenges to
ensure that any desirable functionality required of the pre-
or probiotic is retained by contact with the skin. In many
situations this is hard to ensure due to the environmental
exposure of the body, hygiene and the constant association
with clothes. Positively, however, and unlike probiotics, any
potential efficacy of a prebiotic is retained in a formulation
due to the relative stability of the carbohydrates (even in
relatively harsh formats). This can often not be the case for
other types of skin intervention ingredients.
103
 F.H. Al-Ghazzewi and R.F. Tester
6. Overview
The use of pre- and probiotics for skin care is in its infancy.
However, there are a number of products that are beginning
to incorporate pre- and/or probiotics in their formulations.
There are considerable challenges ahead but also many
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opportunities.
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