APR 2018

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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We also lose our ability to fi ght oxidation as we get older because we have a lower number of antioxidants in our skin. "Several benefi cial strains have free radical scavenging properties. So they can help fi ght skin aging that way," says Dr. Kober. Currently identifi ed antiaging strains found on the skin include Bacillus coagulans, Lactobacillus plantarum, Lactobacillus paracasei and Bifi dobacterium breve. "These are all probiotics that have been shown to have either antioxidant, free radical scavenging properties or they boost ceramide production in the skin, reduce the depth and number of wrinkles in the skin and protect against UV rays," says Dr. Bowe. PUTTING IT IN A BOTTLE As researchers identify specifi c strains of benefi cial bacteria, they are also working to fi nd the best ways to deliver those good bacteria back to the skin. Topically, the three options include products that contain either probiotics, which are the live bacteria; prebiotics, which act as fertilizer or food to encourage the growth of good bacteria; or postbiotics. "Postbiotics are the sub- stances produced and secreted by the live bacteria, such as antimicrobial peptides," explains Dr. Bowe. "If you grow a bunch of bacterial cells and then separate the cells from the broth surrounding them, that broth is considered a postbi- otic. Also in this category are lysed or heat-killed bacteria. What we are learning is that you don't actually need the live bacteria to have an impact on the health of the skin." Thermal water is a prebiotic used by brands including La Roche-Posay and Eau Thermale Avène. "There are certain aspects to thermal water that can make it a prebiotic— things like the mineral content and the pH of the water," says Dr. Bowe. "The types of molecules in the water can encourage the growth of a very diverse array of bacteria on the skin's surface." Johnson & Johnson presented a poster on the use of colloidal oatmeal as a prebiotic for atopic dermatitis at the 2018 American Academy of Dermatology Conference in San Diego, California. Fang Liu-Walsh, et al, compared Aveeno Eczema Therapy Moisturizing Cream, an emoil- lent cream containing 1 percent colloidal oatmeal, to a daily moisturizing lotion. The patients using the Aveeno cream showed a signifi cant increase in skin hydration and microbial biodiversity and a decrease in skin pH, while no change was observed with the daily lotion. "Staph epidermidis grows faster than S. aureus and P. acnes in the presence of the oat fl our, which also lowers the skin pH," says Kimberly Capone, PhD, head of Johnson & Johnson's microbiome platform. "There are a few probiotic creams available on the market—including Aurelia, Mother Dirt and the Eminence Clear Skin Probiotic Mask—that have several different bacterial strains. But because they are in the cosmeceutical realm, they have not been clinically tested," says Dr. Kober. Brands using postbiotics include La Roche-Posay, which uses heat-killed bacteria in its Lipikar Balm AP+ indicated for dry skin, and GlowbioticsMD. "Glowbiotics has some pretty impressive data showing that its postbiotics, which the company calls 'probiotic-derived bioactives' or 'PDB' do impact the health of the skin in a number of ways. For example, PDB upregulated the expression of multiple collagen molecules and downregulated the production and expression of infl ammatory molecules such as interlucan-6 (IL-6) as well as the expression of MMPs, the enzymes that break down collagen," says Dr. Bowe. She notes that even products that contain live bacteria require continued use. "Just because you put something on the skin surface doesn't mean it's able to replicate and con- tinue to do anything on the skin," says Dr. Bowe. "Mother Dirt has some interesting data showing that it does have an impact on the skin over time. But you have to continue to use the products every day." THE SKIN-GUT-BRAIN AXIS While researchers and formulators continue to work toward creating effective topicals based on the science of probiotics, patients needn't wait to enjoy the benefi ts. Oral probiotics can also directly affect skin health, thanks to the skin-gut-brain axis. "If you ingest probiotics, you can actually see some of the effects from the oral ingestion at the skin level," says Dr. Kober. A number of studies, includ- ing a December 2012 study published in Photodermatology, © GETTY IMAGES A HEALTHY BALANCE 32 APRIL 2018 | Med Esthetics "If you ingest probiotics, you can actually see some of the effects from the oral ingestion at the skin level."

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