The Great Skincare Debate: Probiotics vs. Antibiotics


The new surge in probiotic skincare is confusing, especially if you’ve ever been prescribed topical antibiotics to treat acne. One is meant to kill bacteria, and one is meant to encourage its growth. They’re opposites, aren’t they? Yet, both routes claim to lead to clearer skin with fewer breakouts.

The Negative has the floor first—antibiotics.

Antibiotics kill or prevent the multiplication of bacteria specifically, and they are also anti-inflammatory. “Antibiotics are usually prescribed for the treatment of acne or rosacea, and are used for their anti-inflammatory properties,” says Dr. Mona Gohara, Associate Clinical Professor of Dermatology at Yale University. Whether oral or topical (or both), antibiotics are prescribed on a
short cycle in order to prevent antibiotic resistance—or, strains of bacteria specifically evolved to survive through an antibiotic wipeout.

And, now, the Affirmative. Probiotics!

By now, you may have heard of something called your skin’s
microbiome—it’s the delicate ecosystem of microorganisms that naturally live on your skin. Your skin’s microbiome helps with sebum regulation, protection from the elements, and aids in immune system function. Your skin’s natural bacteria is either harmless or helpful, and as in specialized ecosystems like the rainforest and reefs, the more diversity, the better.

The latest skincare products might tout pre-, pro-, or post-biotics—or all three. “Pre-biotics are the substrates that feed and nourish the natural, good bacteria on your skin and help them thrive,” says microbiologist, cosmetic chemist, and co-founder of The Inkey List, Mark Curry. Whereas post-biotics are their byproducts. Bacterial products are fermented, like kombucha, and a few studies (like this one that came out of Seoul , this one from UC San Diego, and this one from 2010) have shown them to be helpful in reducing inflammation and P. acnes. Probiotics are “traditionally live cultures,” says Curry, which makes them difficult to formulate into stable skincare with a decent shelf life. “The two solutions are either to make short-date products you keep in the fridge, or use alternative, non-live products that mimic them. In The Inkey List’s Multibiotic, Aurelia and Galinee molecules mimic the communications of good bacteria to make conditions more favorable to them.”

“Your body’s immune system is finely tuned to recognize good versus bad things,” Curry explains. “Usually, good bacteria have markers on the outside of them to signal that they are good for the body, ensuring our immune system does not destroy them.” With the inclusion of "good bacteria," the idea is that the more diverse bacteria present, the more obvious it is to your immune system when something bad pops up. It’s kind of like the rainforest, or a coral reef, in that way. Plus, Curry adds, “the presence of more good bacteria means that they can outcompete bad bacteria for food and limit their growth.” However Dr. Gohara said she’s skeptical. “I’ve done a lot of research on pre, pro, and postbiotic skincare, and there just isn’t data out there proving their efficacy,” Dr. Gohara explained. But even though she’s not sold on probiotic skincare, Dr. Gohara adds, “Using microbiome-friendly products is essential and important in treating inflammatory skin conditions.”

So which side is the winner?

Refreshingly, it might not be an either/or—antibiotics and probiotics actually go hand in hand, at least when taken orally. “When someone takes oral antibiotics for any of the above mentioned skin conditions, I also recommend oral probiotics,” says Dr. Gohara. That’s because antibiotics wipe out all bacteria indiscriminately—good and bad. It’s possible the answer to the great bacteria debate lies in treating topicals with the same philosophy: antibiotics for a clean sweep, along with probiotics to help rebuild the good. More research and clinical trials will be necessary to know for sure.

—Ali Oshinsky

Photos via ITG