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Received: 25 August 2022    Revised: 29 September 2022    Accepted: 12 October 2022

DOI: 10.1111/jocd.15464

REVIEW ARTICLE

Review of the microbiome in skin aging and the effect of

a topical prebiotic containing thermal spring water

Heather Woolery-­Lloyd MD, FAAD1 | Anneke Andriessen PhD2  | Doris Day MD3 |

Noelani Gonzalez MD4 | Lawrence Green MD5 | Elizabeth Grice PhD6  |
Michelle Henry MD, FAAD7

1
Skin of Color Division Dr Phillip Frost
Department of Dermatology and Abstract
Cutaneous Surgery University of Miami,
Background: Interest in the skin microbiome and the cosmetic benefits of probiotics,
Miller School of Medicine Miami, Miami,
Florida, USA prebiotics, and postbiotics is increasing.
Aim: The current review explores the influence of the skin microbiome on facial skin
2
Radboud UMC Nijmegen, Andriessen
Consultants, Malden, The Netherlands
3
aging and the effects of oral and topical probiotics, prebiotics, and postbiotics use on
NYU Langone Health, New York, New
York, USA skin aging and cosmetic outcomes.
4
Mount Sinai Hospital, New York, New Methods: Five dermatologists who treat clinical signs of facial skin aging and a mi-
York, USA
5
crobiome scientist (advisors) explored the relationship between the skin microbiome
Dermatology, George Washington
University School of Medicine, Diplomate, and skin aging. Published evidence and the advisors' knowledge lead to guidance on
American Board of Dermatology, the skin microbiome using oral and topical prebiotics, probiotics, and postbiotics to
Member, Board of Directors, American
Academy of Dermatology, Past President, reduce signs of aging.
Montgomery County Medical Society, Results: The role of the microbiome in aging skin is an emerging concept. A diverse
Rockville, Maryland, USA
6 skin microbiome is essential for skin health. Preliminary studies suggest oral probiot-
Sandra J. Lazarus Dermatology and
Microbiology, Basic Science Research, ics and prebiotics may play a role in reducing signs of skin aging, likely through shifting
Department of Dermatology, Penn
to a greater skin and gut microbiome diversity. Thermal spring water contains probiot-
Skin Biology & Diseases Resource-­
based Center, Microbiology, Virology, ics and prebiotics. Preliminary studies suggest topically applied probiotics, prebiotics,
& Parasitology Graduate Group
and postbiotics may improve signs of skin aging, including a reduction in fine lines and
University of Pennsylvania, Philadelphia,
Pennsylvania, USA increased hydration.
7
Skin & Aesthetic Surgery of Manhattan, Conclusions: The panel agreed that oral and topical prebiotics, probiotics, and post-
Manhattan, New York, USA
biotics may play a role in improving signs of aging by improving the skin microbiome.
Correspondence Larger studies with more prolonged treatment trials are needed to better understand
Anneke Andriessen, Radboud UMC
Nijmegen, Andriessen Consultants,
the microbiome's role in skin aging and the possible benefits of prebiotics, probiotics,
Malden, The Netherlands. and postbiotics use.
Email: anneke.a@tiscali.nl

KEYWORDS
postbiotics, prebiotics, probiotics, skin aging, skin microbiome

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2022 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.

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96    
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WOOLERY-­LLOYD et al.
1  |  BAC KG RO U N D
The skin is colonized with diverse microorganisms, including bacte-
ria, fungi, viruses, and arthropods. Genomic approaches to identify
the skin's microbiome have revealed a more extensive range of mi-
croorganisms than previously shown with culture-­based methods.
The microbiome of healthy skin varies depending on age and body
area, with differences in sebaceous, moist, and dry areas.1 Lifestyle
and ultraviolet light (UV) exposure also impact the skin microbiome.
The diversity of the skin microbiome changes in skin disorders such
2 3
as atopic dermatitis (AD) and seborrheic dermatitis.
Preliminary studies suggest that oral or topical probiotics, prebi-
otics, and postbiotics may improve the skin microbiome diversity to
reduce facial signs of aging.
2  |  S K I N M I C RO B I O M E A N D AG I N G
Skin aging is associated with a variety of physiologic changes. A study
comparing younger and older women demonstrated age-­related dif-
ferences in the skin microbiome.4 Young Japanese women (aged
21–­37) had greater microbiome diversity compared with healthy
older Japanese women (aged 60–­76).4 The microbiome observed in
the older subjects' forehead, cheek, and forearm contained greater
species richness than in the younger group, including an increase in
many oral bacteria. An age-­related decrease in the Propionibacterium
may have also contributed to the increased bacterial diversity ob-
served in the older subjects. The authors observed a positive corre-
lation between sebum level and the abundance of Propionibacterium
in forehead skin. In this study, older women had about half the
amount of forehead sebum compared to younger women.4
Propionibacterium can be a beneficial skin commensal through
its secretion of antimicrobial substances, immunomodulation, and
short-­chain fatty acids.5 Age-­related changes in the skin microbiome
may be due to the changes in skin physiology as subjects age, spe-
cifically decreased sebum production after menopause. The greater
diversity in older women mirrored a reduction in Propionibacterium,
the lack of which may have allowed the growth of more diverse bac-
teria.4 The authors concluded the skin's microbiome could be an ob-
jective measure to predict skin age.
In a study of 495 American subjects aged 9–­78 years, health and
lifestyle data were collected to determine how the skin microbiome
differs in response to intrinsic and extrinsic factors.6 Data collected
included skin, scalp, and oral microbiome sampling; sebum mea-
surements; facial imaging; non-­invasive biophysical measurements;
demographics, and self-­reported health and lifestyle data. Data anal-
ysis focused on how skin microbiome variations are associated with
demographics, lifestyle, and physiologic factors. Various statistical
modeling tools lead to the following observations: (1) demograph-
ics, lifestyle, and physiological factors did affect the skin microbiome
composition. Collectively these factors explained about 12–­20% of
microbiome variability.6 The microbiome was also influenced by skin
porphyrins, sebum, age, hair color (possibly due to age-­related gray
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      97
hair), skin pH, oral antibiotic use, heavy alcohol use, exercise, sun pro-
tection, wrinkles, and ethnicity. (2) age-­related skin findings, specif-
ically wrinkles, and spots, were associated with two Corynebacteria
taxa. The Corynebacterium signal was especially consistent in older
forehead skin and corresponded with wrinkles and spots.6 These ob-
servations may suggest a link between specific bacteria in the fore-
head and aging skin. The observation that lifestyle factors measured
in this study did not affect the specific taxa associated with aging
(Corynebacteria) suggests that certain skin microbiome species
flourish in aging skin independently of extrinsic lifestyle factors.6
Lifestyle influences skin aging, especially ultraviolet light expo-
sure.7 Further studies are needed to examine other lifestyle fac-
tors such as diet and skincare on the microbiome and skin aging.
Demographics, lifestyle, and physiologic factors do appear to influ-
ence the skin microbiome, but in this study, the microbiome taxa
associated with age-­related skin findings (wrinkles and spots) were
less dependent on extrinsic factors such as UV exposure.
3  |  M I C RO B I O M E A N D D E R M A L FI LLE R S
Inadequate skin preparation when injecting cross-­linked hyaluronic
acid (HA) fillers may cause infections and can exacerbate existing
skin infections, inflammation, periodontal disease, and sinusitis.8
Netsvyetayeva and colleagues9 evaluated skin flora found in pa-
tients with late-­onset biofilm infection after HA injections occurring
1–­18 months (mean 5.2  months) after injection of cross-­linked HA
from various manufacturers.
Biofilms have been implicated in granuloma formation and late
bacterial infection after fillers. Reports suggest that fillers can sup-
port the growth of biofilm in vitro.10
This study aimed to determine whether patients with a late-­
onset infection had pathogenic flora in their nares. Ten previously
healthy women with newly diagnosed late bacterial infection after
HA augmentation were compared with a control group of 17 unaf-
fected women who received similar HA fillers. Both groups had their
skin flora cultured from nasal swabs. The control group had signifi-
cantly higher levels of beneficial Staphylococcus epidermidis than the
study group.9 Those with infections had significantly higher levels
of pathogenic bacteria, including Staphylococcus aureus (p = 0.005),
Klebsiella pneumoniae (p = 0.006), Klebsiella oxytoca (p = 0.048), and
Staphylococcus haemolyticus (p  =  0.048) when compared with the
control group.9 The differences in nasal skin flora may predispose
filler recipients to a late-­onset biofilm infection. A limitation of this
study was that baseline skin flora was not sampled before injection.9
4  |  O R A L PRO B I OTI C S A N D PR E B I OTI C S
I M PAC T S K I N H E A LTH A N D AG I N G
Probiotic food supplements contain viable microorganisms that alter
the host's microbiome. Prebiotic food supplements contain nondi-
gestible ingredients that stimulate indigenous bacteria (Table 1).
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98      WOOLERY-­LLOYD et al.
TA B L E 1  Summary of oral probiotic, prebiotic, and postbiotic studies
Author/year Intervention
11
Mori et al 2016 Oral probiotic (Bifidobacterium) + prebiotic GOS
Miyazaki et al 201412 Oral Bifidobacterium + GOS
13
Lee et al 2015 Oral Lactobacillus plantarum HY7714
Bouilly-­Gauthier et al 201014 Oral Lactobacillus johnsonii + carotenoids
Cardelle-­Cobas et al 201115 Oral prebiotic (GOS) effect on gut flora
Jung et al 201716 Oral Prebiotic (Lactulose + GOS)
17
Hong et al 2017 Oral prebiotic (GOS)
Baba et al 200618 Oral Lactobacillus helveticus
Abbreviations: GOS, Galacto-­oligosaccharides; LRP-­TSW, La Roche-­Posay thermal spring water; TEWL, Transepidermal water loss; TSW, Thermal
spring water; UVA, Ultraviolet A; Vfe, Vitreoscilla filiformes.
A pilot study of young adult Japanese female students compared
the study group who consumed a fermented milk drink daily for
4 weeks versus the control group receiving no product.11 The study
product contained the probiotic Bifidobacterium breve, plus the pre-
biotic galactooligosaccharides (GOS). Skin hydration and appearance
were measured, as were urinary levels of phenol and p-­cresol. At
4 weeks, the study group had increased facial skin hydration (corne-
ometer) and improved overall facial skin appearance (Visual Analog
Scale).11 The study group also had lower urinary levels of phenol and
p-­cresol, presumably due to a beneficial effect of the study drink
on gut flora.11 Free phenol and p-­cresol, most notably produced by
Clostridium dificile, are the metabolic products of aromatic amino
acids and are the biomarkers of a disturbed gut. High gut phenol
levels are associated with reduced skin hydration and impaired
12
keratinization. This study suggests that gut flora had decreased
biomarkers of a disturbed gut, and this can contribute to increased
facial skin hydration.11,12
A randomized, double-­blind, placebo-­controlled trial including
110 volunteers with dry skin and wrinkles between 41 and 59 years
old investigated the effects of the probiotic Lactobacillus plantarum
HY7714 (HY7714) on facial skin hydration and signs of photoaging.13
Participants took 1010 CFU of HY7714 (probiotic group) once daily
or a placebo for 12 weeks. Facial skin hydration, wrinkles, skin gloss,
and elasticity values were recorded every 4 weeks. Both groups had
markedly decreased transepidermal water loss (TEWL) at Weeks 4,
8, and 12 compared with baseline, but TEWL was much less in the
probiotic group at Week 12. Wrinkle depth significantly decreased
in the probiotic group by Week 12, along with significant improve-
ment in skin gloss. Another parameter, skin elasticity, improved
13.17% (p < 0.05 vs controls) in the probiotic group after 4 weeks,
and 21.73% (p < 0.01 vs. controls) after 12 weeks.13 The results sug-
gest HY7714 taken orally may provide facial skin anti-­aging benefits.
A dietary supplement containing the probiotic Lactobacillus john-
sonii plus carotenoids was studied to determine if it could protect
skin from early UV-­induced skin damage.14 Trials included more than
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Key findings
Improved hydration; decreased gut phenol and
p-­cresol
Improved skin by decreasing gut phenols
Improved hydration, wrinkles, skin gloss, and
elasticity by study week 12
Improved resistance to high UVA light, extreme
simulated solar radiation, and natural sunlight
Increased favorable gut flora Lactobacillus,
Streptococcus, and Bifidobacterium
Improvement in wrinkle length and depth
Better skin hydration, reduce wrinkles
Decreased severity of sodium dodecyl sulfate-­
induced dermatitis and associated TEWL
100 healthy women with Fitzpatrick type II–­IV skin. Participants
were exposed to three distinct types of UV exposure: high UVA light,
extreme simulated solar radiation, and natural sunlight. Benefits
were determined by comparing skin histology and immunohisto-
chemistry. Assessment of the minimal erythemal dose was made
clinically and with chromametry.14 After 10 weeks, the probiotic
supplement reduced dermal inflammatory cells after UVA exposure.
After simulated and natural sunlight exposure, the mean erythema
dose of radiation increased by 19–­20%. The authors concluded that
the probiotic Lactobacillus johnsonii plus carotenoids reduced signs
of UV-­induced skin damage triggered by simulated or natural sun ex-
posure.14 Results also suggest this dietary supplement may protect
against long-­term UV exposure, reducing the risk of UV-­associated
skin damage.14
An oral prebiotic containing lactulose plus GOS has been reported
to stimulate the growth of health-­promoting bacteria in the gastro-
intestinal tract.16 The double-­blind, randomized, placebo-­controlled
study included healthy women between the ages 40 and 60.16
The active group consumed 4.5 gm of the prebiotic daily for
8 weeks, while the control group took a placebo pill. Quantitative
and qualitative wrinkle-­related parameters were recorded at base-
line and 8 weeks. The treated group had a reduction in measured
facial wrinkle length and depth, while the placebo group had slight
increases in facial wrinkles (p < 0.001). The qualitative physician
scored global aesthetic improvement scale for the treated group
significantly higher than for the untreated group (p < 0.001). The au-
thors' findings suggest that oral consumption of a prebiotic contain-
ing lactulose plus GOS is beneficial to the skin and may represent a
new dietary approach for facial wrinkle care.16
In another double-­blind, placebo-­controlled, randomized study
involving GOS, 84 healthy women aged 30–­69 received either
placebo or active treatment.17 The treated group received 1 gm
of GOS twice daily while the control group took a placebo pill.
Measurements of skin hydration and wrinkles were made at base-
line and after 12 weeks of treatment. At 12 weeks, corneometer

WOOLERY-­LLOYD et al.
values were significantly greater in the treated group than in the
control group (p < 0.05).17 TEWL in the treated group also signifi-
cantly improved. There were also statistically significant differences
in total and percentage of wrinkle areas (crow's feet) between the
two groups after 12 weeks of GOS treatment (p < 0.05). The findings
16,17
of these two studies suggest that oral prebiotic treatment with
GOS may be beneficial to the skin.
The observation that oral probiotics and oral prebiotics enhance
stratum corneum hydration, add photoprotective effects, and dimin-
11,13,14,16,17
ish wrinkle depth and severity suggest changes in the gut
may lead to changes in the skin.
Other studies demonstrate the value of oral probiotics and the
impact of gut health on the skin. Probiotics can restore skin homeo-
stasis after a skin stressor. For example, a study in 2006 showed
that oral use of Lactobacillus helveticus decreased the severity of
sodium dodecyl sulfate-­induced dermatitis and associated TEWL.18
Skin wounds heal faster in humans who receive probiotics.19 In these
cases, intestinal bacteria may influence the skin due to the modula-
tory effects of gut commensals on systemic immunity.
Intestinal dysbiosis, an imbalance of the gut microbiome, is as-
sociated with negative skin effects. Studies11,12 note the association
of high urine or plasma-­free phenol and p-­cresol levels, markers for
gut microbiome imbalance, and reduced skin hydration. In an ani-
mal study, free phenol and p-­cresol from the gut entered the cir-
culation and then accumulated in the skin of mice fed a diet rich in
L-­t yrosine, 20 resulting in reduced corneocyte size and skin dullness.
Studies in humans suggest phenols produced by gut bacteria also
adversely affect keratinocyte differentiation. 20
Gut inflammation may allow intestinal microbiota metabolites to
enter the bloodstream and accumulate in the skin, disrupting skin
homeostasis. 21,22 Furthermore, gut inflammation associated with
inflammatory bowel disease (IBD) has been associated with psori-
asis. An estimated 7–­11% of patients with IBD develop psoriasis.
Proinflammatory Th17 lymphocytes are elevated in the gut and
skin of these patients. Control of Th17 effector cells occurs pri-
marily in the small intestine, suggesting gut manipulation of these
cells may affect psoriasis and other diseases characterized by Th17
23
inflammation.
Other dietary factors can modulate skin physiology. For exam-
ple, green tea metabolites have been reported to be deposited in the
skin, followed by reduced inflammation associated with ultraviolet
radiation. 24 Several studies21,25 suggest that there may be a link be-
tween the gut microbiome and cutaneous homeostasis.
4.1  |  Topical probiotic effects on skin
hydration and wrinkles
In a small pilot study, 29 subjects aged 19–­61 used an anti-­inflammatory
probiotic facial mist for wrinkles.26 The active ingredient, Nitrosomonas
eutropha, a non-­pathogenic bacterium, oxidize ammonia in sweat to
nitrite and nitric oxide, which have anti-­inflammatory effects. Pre-­
trial data showed Nitrosomonas eutropha reduced the number of
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      99
pathogenic bacteria on the skin and improved skin healing.26 In this
study, one group used a mist containing low doses of Nitrosomonas
eutropha. The other group used a high-­dose mist. High-­resolution pho-
tographs obtained at baseline were compared with photographs made
after 7 days of twice-­daily facial mist use. Wrinkle depth and severity
seem to have improved in the higher dose group. Forehead and glabel-
lar pigmentation also improved in the higher dose group.26 A longer
study in a broader age range, including a larger cohort, would further
evaluate the possible benefits of this probiotic (Table 2).
A postbiotic is a nonviable bacterial product from probiotic or-
ganisms that have biologic activity in the host. In a study involving
middle-­aged women, a topical cream containing a probiotic lysate of
the bacterium Streptococcus thermophiles was studied in 20 healthy
Caucasian women over the age of 60. 27 The lysate contains sphingo-
myelinase, an enzyme that converts sphingomyelin to phosphocho-
line and ceramide, providing a means for ceramide production. The
cream was applied twice daily for 15 days on one arm; the untreated
arm served as the control. After 15 days, the treated areas had signif-
icant increases in hydration and in stratum corneum ceramide levels.
The experimental postbiotic cream improved the lipid barrier and
reduced water loss. 27
Another topical product, created from the cell-­free, casein-­free
supernatant of Lactobacillus helveticus NS-­8 fermented milk, was
studied for its protective effects against UV light-­induced oxida-
tive damage and hyperpigmentation. 28 In vitro antioxidant assays
showed significant free radical scavenging activity. NS-­8 fermented
milk supernatant also inhibited melanin production in in-­vitro mel-
anoma cells and inhibited the expression of proteins needed for
melanin synthesis. 28 Based on its positive in vitro effects, this pro-
biotic was studied in an animal model. Topical application blunted
UVB-­induced skin photodamage. In addition, topical use improved
epidermal thickness, reduced TEWL, and favorably modulated lipid
peroxidation levels. Although the authors could not identify the
compound responsible for these protective effects, they concluded
that topical use of the supernatant of NS-­8 fermented milk has po-
tential for UVB photoprotection. 28
Mineral waters for curative purposes have been used for cen-
turies, even though their use has been empirical. The composition
of mineral water depends on the geologic nature of the ground
from which it springs, so not all thermal spring mineral water is
the same. 29 Water sourced from the town of La Roche-­Posay in
France (LRP-­TSW) contains prebiotics, selenium, and strontium. 29
Strontium is known for its anti-­itch qualities. 29 Selenium is a compo-
nent of several enzymes essential in oxidative-­reduction reactions
that confer antioxidant properties. Selenium acts as a cofactor for
glutathione peroxidase, which aids in removing harmful peroxides;
it participates in DNA synthesis and repair and prevents oxidative
stress from UVB radiation.30 Selenium may also influence bacterial
growth. 29,31
In vitro studies of oxidative damage in human fibroblasts
exposed to UVB and hydrogen peroxide showed higher cell sur-
vival when cultured in media that contained LRP-­T SW. This ef-
fect could be due, in part, to the effects of selenium. 29 Similarly,
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100      WOOLERY-­LLOYD et al.

TA B L E 2  Summary of topical probiotic, prebiotic, and postbiotic studies

Author/year Intervention Key findings

19
Bekiaridou et al 2021 Literature review of human and animal wound healing Reported improved wound healing with probiotics
strategies
Notay et al 202026 Topical Nitrosomonas eutropha Wrinkle depth and severity improved. Improved
forehead and glabellar age-­related pigmentation
DiMarzio et al 200827 Topical sphingomyelinase from Streptococcus Increased skin ceramide levels
thermophilus
Rong et al 201728 Topical supernatant from Lactobacillus helveticus Enhanced resistance to UVB-­induced oxidative stress
and hyperpigmentation
Zeichner et al 201831 Review of topical use of LRP-­TSW as probiotic and Enhanced diversity of skin microbiota; clinical
prebiotic improvement in inflammatory skin diseases
Zeichner et al 201831 Reviews of topical LRP-­TSW Increase in beneficial Xanthomonas; decrease in
Baldwin et al 201733 pathogenic Staphylococcus aureus
Seite et al 201434 Topical emollient containing LRP-­TSW for AD Improved microbiome and skin health in AD
35
Seite et al 2013 Topical product containing LRP-­TSW for rosacea Diminished rosacea-­related skin sensitivity
Gueniche et al 202136 Topical Vfe, a non-­pathogenic bacterial component of Vfe stimulates antioxidant defenses; Vfe activity at
Mahe et al 200637 LRP-­TSW mRNA and protein levels suggests it induces skin
cells to produce their own protective defenses
against exogenous and endogenous stressors

Abbreviations: AD, atopic dermatitis; GOS, galacto-­oligosaccharides; LRP-­TSW, La Roche-­Posay thermal spring water; TEWL, transepidermal water
loss; TSW, Thermal spring water; UVB, ultraviolet B; Vfe, Vitreoscilla filiformes.

studies of human keratinocytes exposed to UVB showed better
cell survival after radiation if cultured in LRP-­T SW. 29 When ap-
plied topically in human subjects, LRP-­T SW protects against UVB
29
effects.
Other in vitro studies confirm the anti-­inflammatory properties
of LRP-­TSW. Human cells exposed to trinitroenzenfulfonaic acid in
cultures containing LRP-­TSW demonstrated diminished numbers of
32
migrating Langerhans cells. In a reconstructed skin model, inflamma-
tory cytokines (interleukin 1α, interleukin 6, and tumor necrosis factor-­
29
alpha) decreased when inflamed skin was exposed to LRP-­TSW.
LRP-­TSW has therefore shown protection against radical oxygen
species and against UVB damage in human skin. Other studies of
LRP-­TSW demonstrate anti-­inflammatory, anti-­irritant, and anticar-
29
cinogenic properties.
In its natural state, LRP-­TSW is a probiotic containing low con-
centrations of diverse organisms, but when processed, it becomes
a prebiotic, that is it contains nonviable bacterial components that
favorably enhance existing skin commensal bacteria.31
Clinical studies demonstrated skin condition improvement in pa-
tients with atopic dermatitis and psoriasis who underwent balneo-
therapy in LRP-­TSW. LRP-­TSW stimulated beneficial Gram-­negative
bacteria on the skin surface, particularly from the Xanthomonadaceae
family. The increase in bacteria of the genus Xanthomonas is asso-
ciated with a decrease in the severity of inflamed skin as levels of
pathogenic Staphylococci decline. In patients with rosacea, a facial
product containing LRP-­TSW, either as monotherapy or as an adjunct
added to an established therapy, provided better symptom control.
Without using antibiotics, LRP-­TSW can therefore modify the micro-
biota enough to help normalize diseased human skin.29,31,33–­35
In humans with dry skin, using filtered LRP-­TSW, either as a mist
or included in a moisturizer, not only improves skin hydration but also
favorably changes the microbiome. Even when filtered, LRP-­TSW re-
tains considerable amounts of bacteria in the genus Xanthomonas.
In xerosis, higher microbiome levels of Xanthomonas correlate with
increased skin hydration levels and improved appearance.33
Another beneficial non-­pathogenic Gram-­negative bacterium
found in LRP-­TSW is Vitreoscilla filiformes (Vfe). Extensive studies
of the Vfe lysate demonstrate multiple beneficial effects on skin
health. Studies demonstrate immunoregulating, soothing, and anti-
oxidant benefits.36 Vfe works by binding to toll-­like receptors pres-
ent on keratinocytes, melanocytes, sensitive neurons, Langerhans
cells, and dendritic cells.36 Vfe can modulate skin immunity, decrease
skin inflammation, stimulate skin defenses, and improve the skin bar-
rier by enhancing tight skin junctions.36
Vfe application trials in humans with Fitzpatrick type II-­III skin
show photoprotective effects. Application protected against sun-
burn cell formation due to Vfe-­enhanced function of a significant
inducible free-­radical scavenger in the skin, suggesting Vfe induces
skin cells to produce endogenous protective defenses against en-
vironmental stressors such as UV radiation and other harmful free
radicals involved in skin aging.37
Taken together, the unique qualities of LRP-­TSW deliver benefits
of reduced oxidative stress, an enhanced skin barrier, and a healthy
skin microbiome. In aging skin, these benefits may improve skin
quality and appearance.
5  |  CO N C LU S I O N S
The role of the microbiome in aging skin is an emerging concept.
A diverse skin microbiome is essential for skin health. The advi-
sors agreed that oral prebiotics and probiotics, as well as topical

WOOLERY-­LLOYD et al.
prebiotics, probiotics, and postbiotics, may play a role in improving
signs of aging by improving the skin microbiome. In addition to oral
agents, topical application of probiotics, prebiotics, and postbiotics
may improve wrinkles, age-­related pigmentation, and skin hydration.
A prebiotic moisturizer containing LRP-­TSW was reported to protect
against oxidative stress and prevent UV-­induced damage. Aesthetic
benefits include reduced wrinkles, better UV resistance, and im-
proved skin hydration. Treatments based on skin microbiota offer
promise, though more studies about the role of microbiota on skin
aging will help identify which treatments will offer benefits.
AU T H O R C O N T R I B U T I O N S
HWL, AA, DD, NG, LG, EG, and MH contributed to the development
of this work and its review and agreed with its content.
AC K N OW L E D G M E N T S
HWL, AA, DD, NG, LG, EG and MH disclosed receipt of the following
financial support for the research, authorship, and publication of this
manuscript. This work was supported by an unrestricted educational
grant from La Roche-­Posay US.
C O N FL I C T O F I N T E R E S T
HWL, AA, DD, NG, LG, EG, and MH have no further conflict of inter-
est with this work.
DATA AVA I L A B I L I T Y S TAT E M E N T
Data sharing is not applicable to this article as no new data were cre-
ated or analyzed in this study.
ORCID
Anneke Andriessen  https://orcid.org/0000-0001-5930-4162
Elizabeth Grice  https://orcid.org/0000-0003-3939-2200
Michelle Henry  https://orcid.org/0000-0001-8164-3291
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How to cite this article: Woolery-­Lloyd H, Andriessen A,
Day D, et al. Review of the microbiome in skin aging and the
effect of a topical prebiotic containing thermal spring water.
J Cosmet Dermatol. 2023;22:96-102. doi: 10.1111/jocd.15464