Balancing the skin microbiome may heal acne, but experts aren’t sure whether taking an oral or topical probiotic is best.

Probiotics are hailed as a must-take for general wellness, but they could be integral for skin health as well.

In a new study, researchers concluded that the skin microbiome, or bacterial balance of the skin, has more to do with acne development than a single type of bacteria.

Just like the gut microbiome, there are good and bad bacteria on our skin — and finding the right balance could improve skin health.

Propionibacterium acnes has long been the bacterial culprit of acne, but Dr. Huiying Li, an associate professor of molecular and medical pharmacology at the David Geffen School of Medicine at the University of California Los Angeles (UCLA), said that isn’t necessarily the case.

Li told Healthline that her results indicate that acne isn’t due to just one bacterial strain.

“People usually think of it as one bad bacteria, but it’s a system of good and bad,” she said. “It’s really the balance of the microbes.”

“Bacteria are not all bad. Actually, they do a lot of good things for us,” Li added.

Read more: Get the facts on acne »

Genetic factors can also impact the skin’s microbiome, and vitamin B-12 could be one of those factors, Li noted.

Her team evaluated skin follicle samples from 72 people — 38 had acne and 34 did not.

After examining DNA to compare the microbiomes of the samples, researchers said there were differences in the bacteria between the two groups.

In the group without acne, the microbiome had genes linked to bacterial metabolism, which are thought to be important in preventing harmful bacteria from colonizing the skin.

Those with acne had higher levels of virulence-associated genes. These included those linked to the transport of bacterial toxins that are harmful to skin.

Li said that the makeup of bacteria in the follicles is a good indicator of skin health. As such, targeted skin treatments to control the skin microbiome could help strike a healthy bacterial balance and lead to healthier skin.

This may be more favorable than using antibiotics that can kill harmful and helpful skin bacteria. In other words, giving skin healthy bacteria could improve it — the same way that taking a probiotic improves gut health.

Phage therapy or taking a probiotic may be ways to clear skin, she said. Her team also validated the findings using samples from 10 more people.

“Instead of killing all bacteria, including the beneficial ones, we should focus on shifting the balance toward a healthy microbiota by targeting harmful bacteria or enriching beneficial bacteria,” Dr. Emma Barnard, a researcher in the Department of Molecular and Medical Pharmacology at UCLA’s David Geffen School of Medicine, said in a statement.

Read more: The relationship between stress and acne »

Knowing that probiotics could be key to healthier skin, is popping a pill enough to make a difference in our skin microbiome?

That depends on whom you ask.

Li says a topical probiotic could be all it takes balance out the bacteria on the skin.

“If we can modify the microbiome, that could potentially help the condition,” she said.

Finding out if it’s modifiable is the subject of Li’s future research.

Dr. Joshua Zeichner, a dermatologist from New York, told Healthline that therapies to eliminate harmful bacteria and replace them with healthy bacteria can minimize skin inflammation and will be future targets for acne medication.

Dr. Julia Oh, a researcher from The Jackson Laboratory in Connecticut, who is focused on studying the microbiome, noted that Li’s study focused on the skin microbiome — not the gut microbiome.

So taking an over-the-counter probiotic may not impact the skin.

“It is unknown if an oral probiotic can affect the skin,” she said. “I would be willing to bet that it does, but there is little concrete research to date to suggest the particular strains or mechanisms.”

She said a topical probiotic that modulates the skin microbiome “should be a good bet, particularly if the topical probiotic is either immunomodulatory or if it suppresses the ‘bad’ skin microbes,” Oh added.

Dr. Debra Jaliman, a dermatologist based in New York, told Healthline that oral probiotics definitely have a positive impact on the skin’s microbiome.

“Topicals don’t penetrate as well as an internal probiotic would,” she said.

She noted that VSL#3 includes eight probiotics. Just make sure to keep the probiotic on ice when purchasing, and keep it refrigerated, Jaliman noted.

Another New York-based dermatologist, Dr. Whitney Bowe, agreed that oral probiotics can help. She’s studied the gut-brain-skin axis, and told Healthline that she believes oral probiotics do work to balance the skin’s microbiome.

Her team is also looking at whether diet alone can help or if supplements are needed to regulate the skin microbiome.

“All of this research is in the early stages, but there is mounting evidence to suggest that oral probiotics and dietary modifications will absolutely play a major role in the future of acne therapy,” said Bowe. “I believe it will ultimately be a combination approach that is most successful.”

But Dr. Maggie Kober, a dermatologist from California, said there aren’t enough studies to say whether an oral or topical probiotic is better. But there is growing evidence that oral probiotics can help skin, she said.

“Using topicals and oral probiotics together may lead to greater improvement as it balances the microbiome superficially as well as from within,” Kober told Healthline.