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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34 APRIL 2018 | Med Esthetics © GETTY IMAGES Photoimmunology and Photomedicine and a July 2014 study published in Archives of Dermatological Research, showed that an oral probiotic containing Bifi dobacterium breve attenuated UV-induced photodamage. "The mecha- nism of that is not yet fully understood but it shows the far-reaching effects of probiotics on the skin even when taken orally." says Dr. Kober. Dermala, a new probiotic-based acne line from Johnson & Johnson, includes an oral probiotic and a prebiotic-based topical to help restore balance to the skin microbiome through both direct contact with the skin and the skin-gut-brain axis. Dr. Bowe recommends an oral probiotic to all of her patients and also offers instruction on how to develop a microbiome-friendly skincare regimen. "With any kind of skin issue there is nature vs. nurture," she says. "We can't do much about our genetics. However, there is a lot about our microbiome that is under our control, and it can be directly impacted by our skincare routines, our hygiene habits, our diet and our stress levels." PRESERVING A HEALTHY SKIN MICROBIOME Hygiene and skincare habits that can wreak havoc on the skin microbiome include overexfoliation and extended hot showers. "Extreme temperatures, over-cleansing and over-exfoliating can damage the skin barrier and damage your skin microbiome," says Dr. Bowe. "To keep your skin's microbial community healthy and varied, choose a gentle, low-foam, pH-balanced, soap-free cleanser that leaves skin hydrated, not taut." She recommends using only one type of exfoliator—a physical scrub or chemical exfoliant—and limiting its use to once or twice a week. "Using a chemical and physical exfoliant can disrupt the skin barrier and create unhealthy shifts in the type of bacteria on the skin," says Dr. Bowe. "Also, a lot of bacteria require moisture or water to grow and thrive on the skin. So using moisturizers—anything that is gong to trap moisture—is key. You don't want to let the skin get very dry." Dr. Kober recommends moisturizing products that contain ceramides to her patients. "They help maintain the skin barrier and hydration, and that can help protect the skin microbiome," she says. "Moisturize frequently in the winter months and wear sunscreen. UV light can cause damage and changes to the skin's composition." Returning to the skin-gut-brain axis, dietary habits can also affect skin health. "Things like refi ned carbohy- drates devoid of fi ber can encourage the growth of very unhealthy bacteria in the gut, triggering system-wide in- fl ammation, which manifests in the skin," says Dr. Bowe. "We're learning that in terms of diet, we need to look at low glycemic index whole or unprocessed foods, such as multigrain breads, quinoa, sweet potatoes, barley and vegetables vs. bagels, cornfl akes or white bread." STILL LEARNING While our understanding of the skin microbiome is growing, there is still much to learn. "The microbiome on different parts of our bodies are very different, and each person's microbial signature is unique. So what might be good for one patient may not be good for another," says Dr. Bowe. "And we're still in the process of learning what are the good bacteria that keep skin healthy on the forehead vs. the back or neck, and how that compares to people who have skin concerns." When comparing different sites on the body, research- ers at Johnson & Johnson discovered that while the moist underarm area has decreased diversity of bacteria, as expected, dry areas such as the legs have more diversity than healthier facial skin. "This suggests that the 'increasing diversity is good' theory is too simplistic," Capone says. "It could be more like a pendulum where too little diversity is bad, too much diversity is bad, and your middle is healthy skin," says Menas Kizoulis, head of beauty and global scientifi c engagement at Johnson & Johnson. Dr. Bowe envisions a future where physicians can use an individual's skin microbiome to identify potential concerns and create personalized product regimens. "We aren't at the point right now where we can swab some- one's skin and say, 'Here's your problem, what you need is more prebiotic A, probiotic B and postbiotic C, and you need to start exfoliating three times a week vs. two. But that is in the near future," she says, adding that as probiot- ics become a hotter and hotter topic, it is imperative that physicians and skincare specialists do their due diligence in researching product claims. "Patients are going to come to us with questions, so it's our job not only to be aware of what probiotics can do but also to push brands selling probiotic-based products to be transparent about the science they have to back their claims," says Dr. Bowe. "We need to guide our patients to be savvy consumers so they can get the most out of this new knowledge." Inga Hansen is the executive editor of MedEsthetics. A HEALTHY BALANCE

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