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Acne vulgaris, probiotics and the gut-brain-skin axis - back to the future?

Whitney P Bowe1 and Alan C Logan2

Author Affiliations

1 Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, New York, 11203, USA

2 Integrative Care Centre of Toronto, 3600 Ellesmere Road, Unit 4, Toronto, ON M1C 4Y8, Canada

Gut Pathogens 2011, 3:1  doi:10.1186/1757-4749-3-1

Published: 31 January 2011


Over 70 years have passed since dermatologists John H. Stokes and Donald M. Pillsbury first proposed a gastrointestinal mechanism for the overlap between depression, anxiety and skin conditions such as acne. Stokes and Pillsbury hypothesized that emotional states might alter the normal intestinal microflora, increase intestinal permeability and contribute to systemic inflammation. Among the remedies advocated by Stokes and Pillsbury were Lactobacillus acidophilus cultures. Many aspects of this gut-brain-skin unifying theory have recently been validated. The ability of the gut microbiota and oral probiotics to influence systemic inflammation, oxidative stress, glycemic control, tissue lipid content and even mood itself, may have important implications in acne. The intestinal microflora may also provide a twist to the developing diet and acne research. Here we provide a historical perspective to the contemporary investigations and clinical implications of the gut-brain-skin connection in acne.