"Probiotik" skincare untuk masalah jerawat: The known and unknown

 

Assalamualaikum

"Letak bakteria atas kulit..gelinya. Am I putting food on my face?"

Ini adalah antara reaksi dan komen netizen berkaitan probiotik dalam produk penjagaan kulit. Probiotic is taken orally and can be used topically (sapuan). But topical probiotic for skincare is maybe a rare sight for some. Imagine rubbing your face with bacteria....good bacteria.

NOTES: This article is written in both English and Malay. I am focusing on skincare products with microbes, not with fermented ingredients (fermented rice, fermented vegies etc.). And this is NOT a product review.

Probiotic intake has always been associated with gut health. The main idea is to replenish our gut with good bacteria. But how does this idea translates into the skincare setting?

For those who never heard of it, probiotic has invaded the skincare community! I am familiar with probiotic cream to treat eczema.  However, to discover probiotic in moisturizer, lotion or even cleanser is really astonishing. 

So, when Allure listed 15 probiotic skincare "..all hand-picked by board-certified dermatologists", my head turns and decided to dedicate my free time to study probiotic skincare.

They are also available in cream, essence, serum, facemask and lotion. I am not a skincare specialist, I am just a skincare noob who wants to have better skin. 

For someone who has a serious acne problem since 2013, and did a research on probiotic, this topic is intriguing. 

Neogen (Seoul, Korea) recently launched skincare probiotic collection in toner, serum, mist and mask

 

When I write this article, I want to find the answer to how probiotic skincare works. Instead, I discover something unexpected. If you thought of live bacteria in probiotic skincare, you might not get what you want.

➡Probiotik 

Back to basic probiotik 101. Probiotik merujuk kepada "..mikroorganisma hidup yang apabila diberikan dalam jumlah yang mencukupi, akan memberikan manfaat kesihatan". Probiotik ialah mikroorganisma, bukan makanan/minuman guys. 

➡Skin microbiome, our body silent neighbour

Sebelum dive in terus kepada probiotik produk, kenali dahulu bahawa organ terbesar manusia iaitu kulit ialah rumah kepada berjuta mikrob.

Mikroorganisma (bakteria dan fungi) pada kulit melindungi badan dari serangan patogen, membantu sistem imun badan and they breakdown natural products on skin (1).

Bakteria komuniti berbeza mengikut fisiologi kulit sama ada kulit lembap, kering atau berminyak. Sebagai contoh, kulit kaki lembap manakala bahagian lengan lebih kering.

Kawasan muka mengandungi sebum yang disukai bakteria Propionibacterium. Manakala, kawasan lembap seperti kaki dan siku mempunyai banyak Staphylococcus dan Corynebacterium (1).

Walau bagaimanapun, apabila  bakteria jahat lagi banyak dari bakteria baik, disbiosis (ketidakseimbangan bakteria) berlaku. Ini membawa kepada masalah kulit sebagai contoh jerawat (acne vulgaris) yang disebabkan oleh pembiakkan Cutibacterium acnes (formerly known as Propionibacterium acnes) yang tak terkawal. 

➡Probiotik dan jerawat

Bagaimana bakteria boleh mengurangkan masalah jerawat?  In general, probiotic can reduce acne problem by (1);

1. Improving the skin barrier function
2. Producing antimicrobial substances to kill bad bacteria

➡Probiotik, Prebiotik dan Posbiotik

First general rule bila inspecting skincare product is to read the ingredient list. Cuba semak moisturizer yang korang hendak atau sudah beli tu.

Apabila Ema semak, akan ada list bahan seperti "Bifidobacterium ferment lysate", "Lactobacillus lysate" atau "Lactobacillus ferment filtrate". Kedengaran seperti probiotik bakteria but here is a twist, they may not be.

Sebelum Ema explains kenapa, let's familiarized ourselves with few terms related to probiotic. 

• Prebiotik: Prebiotik bahasa mudahnya ialah makanan probiotik. Prebiotik tidak bertindak secara langsung, tapi mengalak pertumbuhan bakteria baik. Prebiotik kebanyakkan dari non-digestible plant carbohydrate seperti inulin, fructooligosaccharides, alpha-glucan oligosaccharide dan banyak lagi. 

• Posbiotik: Posbiotik ialah produk hasil daripada proses fermentasi.  Dead microbial cells, cell constituent dan cell metabolites seperti organic acid (lactic acid etc.), short-chain fatty acids, vitamin dan sebagainya dikategorikan dianggap sebagai posbiotik (2).

• Synbiotik: Synbiotik ialah gabungan antara probiotik dan prebiotik. For example, produk synbiotik mengandungi bakteria Lactobacillus (probiotik) dan inulin (prebiotik). 

Kembali pada ingredient -bakteria lysate dan ferment- dalam skincare produk. 

• "Lysate" ialah produk hasil daripada pemecahan sel membran bakteria. Lysate mengandungi bakteria mati, sel dinding bakteria dan other molecules dalam cell intracellular fluid. Cell lysate ialah posbiotik (3).

• "Ferment" ialah produk daripada fermentasi bakteria. Paula's choice describe "ferment" as non-living probiotic ingredient made by fermentation of the microorganism. Bakteria ferment juga ialah posbiotik (4).

In short, bacteria lysate and bacteria ferment is not live bacteria. Oopsies. They can be considered as postbiotic. 

➡Probiotic skincare label. A case of mislabelling?

There are hundreds of probiotic-claimed skincare products. I can't go through each one. I'm choosing product available at Malaysia stores and from well-known brands. So, here is where the confusion began. Most company brands advertise the bacteria/yeast lysate and ferment product very... differently. 

For example, "Innisfree's Green Tea Probiotic (RM72)" and "Neogen's Probiotics Double Action Serum  (RM120)", which clearly stated probiotic, contain Lactobacillus ferment lysate. However,  "Aiken's Prebiotic Hydra Plus Moisturizer (RM30)"  labelled their moisturizer containing Aspergillus ferment and lactobacillus as prebiotic. 

"Paula's Choice Probiotic Nutrient Moisturizer (RM225)" has more complicated ingredients. Lactobacillus ferment, Bifida ferment lysate and Leuconostoc ferment filtrate as probiotic. Interestingly, Saccharomyces lysate is labelled as postbiotics. 

The same ingredient but labelled differently. Some companies may go for a safer route. When I searched on Incidedecoder, there are dozens of Lactobacillus ferment skincare products, but they did not mention -iotic in their product name. 

Another way is for the company to use the word "ferment". For example, "L'Oreal Youth Code Ferment Pre Essence (RM138)" (Bifida ferment lysate). While scanning through these ferment-labelled products, I found another Neogen product! "Neogen Real Ferment Micro Serum (RM143)"  (Bifida ferment lysate, Saccharomyces ferment filtrate and Lactobacillus). Instead of using "probiotic" like its probiotic double-action serum, they opt for label "ferment"... Stop confusing me more Neogen.

According to Dr. Katz. M.D., director of the Office of Cosmetics and Color FDA, "..90% of cosmetic products that carry “probiotic labels” actually have “postbiotics,”". . In short, there is a possibility of no probiotic in a probiotic label skincare product. Am I being scammed?

So, why can't they use prebiotic or postbiotic terms if there are NO LIVE microorganisms in the formulations? They are a few possible reasons. My guess is because the probiotic name is well-known and fancier. Second, there is no actual consensus for prebiotic definition by the FDA/WHO, unlike probiotic. Third, postbiotic is a newly-coined term which is unfamiliar among the public. Fourth, no regulation for probiotic skincare. 

Postbiotic is the new kid on the block. The concept firstly appeared in 1986 but the interest in postbiotic research started to rise in 2015. SOURCE: Wegh et al., 2019

➡Adakah ia berkesan? Scientifically..

Jadi, set aside the confusion on the product labelling. We now have an idea that this skincare contains products of microbial fermentation and also microbial cell constituents  (postbiotic). So, do they actually work?

Ini adalah beberapa kajian klinikal yang dilakukan selepas menggunakan  posbiotik (bacteria lysate and ferment) secara topikal, especially untuk kulit berjerawat.

• Pada tahun 2009, losyen mengandungi ekstrak Enterococcus faecalis SL-5 diberikan kepada pesakit yang mengalami masalah jerawat (n=37) dan placebo (n=33) selama 8 minggu. Rawatan yang diberikan mengurangkan radang jerawat pustules (5). 

• Ujian klinikal selama 2 bulan dijalankan ke atas 66 orang wanita yang mempunyai kulit reactive (33 wanita menerima placebo). Penggunaan krim mengandungi 10% Bifidobacterium longum reuter lysate mengurangkan masalah kulit sensitif (6).

• Syarikat Estee Lauder mengkaji kesan Lactobacillus plantarum extract (1% dan 5%) ke atas kulit. Krim mengandungi 1% Lactobacillus meningkatkan fungsi skin barrier selepas 1 bulan (n=29). Manakala krim 5% Lactobacillus mengurangkan saiz dan erythma jerawat dalam tempoh 4 hari (n=10) (7). 

Seems promising right? This shows the efficacy of some strains of bacterial lysate and extracts on skin problems.

➡Bakteria hidup dalam skincare product with preservative..

Lucky me, Ema jumpa (high-end) skincare brand yang claim menggunakan bakteria hidup dalam formula!

Marie Veronique's Pre + Probiotic Daily Mist (USD 40)

"Our proprietary microbiotic complex contains a combination of 34 probiotic live strains including high concentration of Bifidobacterium, kept in balance with prebiotics to maintain a well-regulated cycle.."

Maklumat tentang bakteria yang digunakan tidak dinyatakan di official website, hanya sekadar state "probiotic" dalam senarai ingredient. The first ingredient is green tea (Which is a good antioxidant)..What can I  say more? 34 live strains? Banyaknya, and questionable. 

Another concern is preservatives. Some skincare used preservatives to inhibit microbial growth in their product to avoid contamination and prolong shelf-life. The preservative can kill bacteria, that includes probiotics. Probiotic food does not have preservative, that is why Yakult can only last for 45 days (TMI). 

Dermatologist Dr. Dray addressed this concern when reviewing Tula's purifying face cleanser with Bifida ferment lysate and preservatives methylchloroisothiazolinone. Another drug store brand listed Lactobacillus and phenoxyethanol (preservative) as the ingredients in its moisturizer.

This is a concern and a challenge for the company to properly packaging probiotic skincare products. To overcome this, skincare company opt to use cell lysate or ferment instead of viable microbes as an alternative (8). 

In the food industry, live probiotics can be found in capsules, where the capsulation protect the probiotic from human harsh digestive environment.  For a brand like ESSE, they applied the same approach by encapsulating Lactobacillus in their Probiotic Serum. 

SUMMARY

In a nutshell, unexpectedly, most of the probiotic skincare actually incorporates bio-active molecules and cell metabolites with no viable microorganisms. 

Probiotic is very compelling but can be a rigorous subject to discuss. One can't talk about probiotic benefits without mentioning its strains. I still have a lot of questions.  

• what are the bacterial species and strains used? 
• single or multi-strain, which more effective? 
• Is the probiotic viable in skincare products with preservatives? 
• Which is better to use, cell metabolites or live cells? 
• How do live microbes interact with other product ingredients such as lactic acid or natural extract with antimicrobial properties?

The probiotic skincare is not regulated. No established regulations are controlling probiotic labelling in the skincare, as part of cosmetic, even FDA (9). 

The information on "probiotic" efficiency is still limited. Besides, most of the "probiotic" are formulated with other active ingredients (Example: Niacinamide, hyaluronic acid, green tea extract). Therefore,  the efficacy actually depends on the final formulations as a whole. 

From the current state, it is generally based upon consumer reviews, testimony from others and self-testing. If the product works, it works. If not..wasting money, no repurchasing and 1⭐ review.

Will I be trying probiotic/postbiotic skincare soon for my acne problem? Probably not because of the cost. Secondly, probiotic/postbiotic skincare is on rising, but the clinical studies on postbiotic are falling back. There is a lack of transparencies. 

What's the point of "Clinically proven" etc. if there is no scientific publication to support their claim. I am not going to fall victim for a mere marketing strategy.  

Bifida ferment lysate is not considered as probiotic, but postbiotic. Still, the idea and innovation behind the probiotic, postbiotic and prebiotic skincare are very promising. This is a new technology, give it a few years. I will wait.

⚠Disclaimer: This is not a sponsored post. All of this information based upon my own research and reading. I am also not associated with any dermatologist, aesthetician and nor do have knowledge beyond these knowledgeable people. Please seeks them to resolve your acne concern.