Treatment of acne vulgaris with oral probiotics
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Acne vulgaris is a chronic inflammatory skin disorder, which affects the pilosebaceous units of the skin. Although this disease is normally self-limiting, it affects over 50 million Americans and results in lost productivity and treatment costs exceeding 1.2 billion dollars annually.1 While the exact cause of acne is unknown, its pathogenesis is classified into four factors: increased sebum production, abnormal keratinization, hypercolonization by Propionibacterium acnes, and inflammation.2 Despite numerous treatment options, increasing resistance to antibiotics3 and significant side effect profiles of many other therapeutics has created a need for safer, gentler treatment options. There has been renewed interest in the gut-skin-brain axis theory and the therapeutic role of oral probiotics, as new evidence suggests that gut dysbiosis plays an important role in mediating cutaneous skin inflammation and acne lesions.2 Specifically, strains of Lactobacillus acidophilus and Bifidobacterium bifidum, two strains commonly found in probiotics, have been found to decrease gut permeability and reduce systemic inflammation associated with acne.4 Additionally, in small clinical trials, these strains decreased acne severity and had an supplemental effect on clinical efficacy when used with oral antibiotics.5 Despite these promising results, the lack of large randomized controlled trials with standardized outcome measurements has prevented the adoption of oral probiotics as a viable treatment option by domestic and international dermatological societies. Therefore, this study proposes a randomized control trial to determine whether the adjunctive use of oral probiotics with antibiotics significantly reduces acne severity compared to oral antibiotics alone. We hypothesize that there will be a statistically significant decrease in acne severity scores among those receiving oral probiotics and antibiotics compared to those receiving only antibiotics among adolescents between the ages of 12-24 with moderate to severe acne. We hope that these study results will help provide evidence to incorporate oral probiotics into practice as a safe and efficacious treatment option to those suffering from moderate to severe acne, while advancing our understanding of how mediating gut microbiota can improve acne outcomes.