Acne. The scourge of many a teenager but certainly not limited to only that age group. Plenty of people in their 20s, 30s, 40s and beyond still battle with the inflammatory condition. For some it may be mild, but for others it can be so disfiguring that just leaving the house becomes a source of great anxiety. Acne not only has the ability to scar the skin permanently but it is the second highest cause of suicides among skin diseases. 
What causes acne?
Acne vulgaris is one of the most common skin diseases.
Each of our hair follicles are connected to a sebaceous gland, which produces an oily substance known as sebum. When too much sebum is produced it can trap both itself and water in our skin cells, plugging the hair follicle.
When the hair follicle becomes plugged a bacteria known as Propionibacterium acnes, which until now had been happily co-existing on the skin, begins to grow and multiply. 
The cellular damage and debris produced by P. acnes can trigger inflammation and this inflammation then makes the follicle susceptible to bacteria like Staphylococcus aureus which is a common cause of skin infections.
Stress, changes in your hormones, diet and birth control pills can all contribute to the overproduction of sebum and therefore, acne.
What are biotics?
Biotics is a broad term given to the community of living organisms on our planet. Plants, animals and even the tiniest of bacteria are considered biotics.
As humans, we are also biotic and we are made up of many billions of even smaller biotics – which when kept in balance live together in perfect harmony.
There are two main areas of biotics that you hear about on an almost daily basis: antibiotics and probiotics.
When we’re sick, we often need to take antibiotics in order to kill a collection of “bad bacteria” which has built up within our body.
Antibiotics were one of the greatest discoveries of the 20th Century as humans were finally able to survive infections that would have previously killed them. Today we are prescribed antibiotics pills for a week and we are miraculously cured. It’s easy to take take for granted just how lucky we are to live in the age of the antibiotic.
However, antibiotics can’t kill “bad bacteria” without taking out some good guys in the process. Think of it as collateral damage.
That’s where probiotics step in.
Stress, poor diet, illness and taking antibiotics can all contribute to an imbalance in your gut flora, and this allows more “bad bacteria” to flourish. So putting “good bacteria” back into your gut becomes an important priority.
Probiotics are “good bacteria” that are similar to the billions of good microorganisms that already live in the body.
They are sold over the counter as daily supplements, but they also occur naturally in fermented foods like natural yogurt, sourdough bread, kefir drinks, kombucha, and even some cheeses.
Consuming probiotics on a regular basis can help to re-establish gut flora harmony which in turn can keep us healthy. The flu, colon cancer, autoimmune conditions (like allergies), obesity and even behavioural issues have shown evidence that they may directly relate to imbalances of the microorganisms living in our guts. 
Using biotics to treat acne
These two main types of biotic treatments, antibiotics and probiotics, can both be used quite successfully in the treatment of acne. The use of antibiotics for acne has been long established but the benefits of probiotics on acne is a relatively new discovery.
Antibiotics and acne
Antibiotics has proven to be one of the most successful treatments for acne, taken either orally or applied to the skin. But one of the big problems with treating acne with antibiotics is that they often need to be taken long-term in order to keep the condition under control.
A single 7 – 10 day course of antibiotics is enough to upset the gut flora so imagine what taking antibiotics for long periods can do to your gut.
Perhaps of greater concern is that long-term antibiotic use can increase the chances of bacteria becoming antibiotic-resistant.  This resistance is also the reason that a doctor won’t prescribe you an antibiotic unless they absolutely deem it necessary.
Science has shown that since the discovery of the antibiotic, bacteria have continued to evolve and develop resistance to certain antibiotics and even worse, often are able to multiply in the presence of the antibiotic. Just like every other living creature, bacteria’s number one priority on earth is survival.
Where it is deemed necessary, usually in severe acne, antibiotics such as tetracycline, minocycline, and doxycycline are all good options but it’s advised that this intake should not exceed 2 – 3 months at a time. 
But antibiotics do only treat the bacterial infection, which is why many acne facial solutions attempt to target the earliest stages of the condition – the control of sebum.
Probiotics and acne
When taking antibiotics, whether long or short term, taking probiotics can be of great benefit. However, probiotics have shown that they may be of greater importance to acne than just combating antibiotics.
There is some evidence that probiotics could be useful in the treatment of acne.
As far back as 80 years ago, dermatologists decided that the gastrointestinal system might be part of the acne problem. They felt that emotional states like depression and anxiety could be responsible for this gastrointestinal upset, as well as contributing to inflammation in the body. They termed this the “gut-brain-skin” inflammatory process.
They also noted that the probiotic Lactobacillus acidophilus (one of the main bacterias in natural yogurt) could be successful in rebalancing the gut. 
More recent research shows that topical probiotics may be just as useful.
In 1999, researchers found that the lactic acid bacteria Streptococcus thermophilus, another species commonly found in yogurt, may increase ceramide production when applied to the skin as a cream for 7 days. Ceramides have been shown to provide antimicrobial benefits against the P. acnes bacteria as well as help with inflammation. 
A study in 2007 showed that topical application of certain ceramides did indeed reduce acne papules and pustules by 89%, while another study showed that the application of a topical probiotic reduced inflammatory lesions by over 50% vs. the placebo group over 8 weeks. 
Though studies are still limited, it would seem that there is great potential for acne sufferers who incorporate probiotics into their diets and/or skin regime.
Cleopatra once swore by milk baths as the secret to her radiant skin so perhaps smearing yogurt on one’s face is not such a crazy idea after all.
 Gupta MA, Gupta AK. Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. Br J Dermatol 1998; 139: 846 – 850.