CPD Article: Rethinking Skincare With a Combined Approach

---

Dr Tatyana Lapa-Enright explains how integrating evidence-based dermatology with microbiome-friendly strategies is transforming both aesthetic and medical skin health.

Dermatological conditions such as acne, rosacea, and dermatitis remain highly prevalent across the Western world.¹ Remedies are available everywhere – from high-street pharmacies and beauty counters to specialist clinics led by trained healthcare practitioners and dermatologists. At the same time, the prevention and treatment of skin ageing continues to attract growing attention. With an ageing population and increasing social emphasis on looking youthful, healthy, and “glowing,” the skincare market is expanding at an unprecedented rate.^2,3

We are also learning more than ever about what truly supports health, resilience, and vitality. By combining evidence-based dermatological care with holistic approaches to wellbeing, we are beginning to understand how to protect the skin, slow the visible signs of ageing, and promote confidence and wellness at every stage of life.

In recent years, the skin microbiome and probiotics have gained increasing attention in both dermatology and aesthetics. How can this new knowledge be integrated into clinical practice and daily skincare?

One already well-established group of treatment ingredients in clinical dermatology and aesthetic medicine are vitamin A derivatives (retinoids, including retinol), widely prescribed for acne, pigmentation disorders, and solar elastosis. These compounds are also available via professional skincare providers and, in weaker forms, over the counter.⁴ Other commonly used ingredients include azelaic acid and benzoyl peroxide, which are accessible both over the counter and by prescription, and are routinely applied in cosmetic and dermatological practice.

However, emerging research suggests that the use of these products can influence the composition of the skin microbiome, sometimes after only short-term application. Some changes are beneficial, for example, reducing the prevalence of certain Cutibacterium acnes strains implicated in acne vulgaris. Yet ingredients such as retinoids, benzoyl peroxide, azelaic acid, and prescription topical and oral antibiotics have also been shown to reduce microbial diversity and, in some cases, induce cutaneous dysbiosis within weeks of use.⁵

Dysbiosis – an imbalance and loss of microbial diversity – has been associated with a range of skin concerns, including inflammation, increased sensitivity to UV radiation, and other skin disorders.⁶ Increasing evidence also highlights a bidirectional relationship between the gut and the skin, the so-called gut–skin axis. This relationship, largely modulated by the microbiome, emphasises the importance of maintaining a balanced and diverse skin microbiota to support both cutaneous and systemic health.⁷ While the use of pharmaceutical agents described above remains gold-standard practice in conventional dermatology, approaches that concentrate on enhancing the microbiome, rebuilding the skin barrier, and adopting a more holistic view of skin health are gaining momentum. Integrating microbiome-friendly formulations into daily routines may provide the best of both worlds, supporting conventional therapies while mitigating some of their unwanted side effects. At Hardwick Clinic, we have adopted this approach.

Our favourite products of choice remain Esse Skincare – a product line specifically designed to support and restore the skin microbiome using probiotics, prebiotics, and postbiotics. Prebiotics (such as inulin and α-glucan oligosaccharide) act as nourishment for beneficial skin microbes, encouraging the growth of protective species that help maintain barrier integrity. Probiotics, whether included as live strains or as lysates, can actively shift the microbial balance in favour of skin health, reducing inflammation and protecting against pathogenic overgrowth. Postbiotics (including lactic acid, short-chain fatty acids, and antimicrobial peptides) deliver many of the same benefits directly, calming inflammation and strengthening the skin barrier. We use these microbiome-focused strategies to complement traditional active ingredients, offering a more balanced approach to both dermatological treatment and aesthetic care.¹

 

Cleansers

Gentle, pH-balanced cleansing (ideally within the 4.5–5.5 range) used once daily helps to respect the skin’s acid and preserve microbial diversity. Harsh surfactants, hot water, and over-exfoliation should be avoided, as these practices can strip natural oils, disrupt the barrier, and reduce beneficial microbial populations. Formulations enriched with prebiotics and postbiotics add further benefit by selectively nourishing protective microbes and delivering bioactive compounds that strengthen barrier function and calm inflammation. We predominantly advise our patients to use ESSE Gell Cleanser and ESSE Sensitive Cleanser. 

 

Make-up removal

Many micellar waters available over the counter are now formulated to be microbiome-friendly and can be used effectively to remove makeup without stripping the skin’s natural oils. These products offer a gentle alternative to harsher make-up removers and makeup-removing wipes. Our long-term favourite remains Bioderma Sensibio H2O, which is widely regarded for its tolerance and microbiome compatibility.

 

Moisturisers and serums

Live probiotic serums, such as the Esse Probiotic Serum, contain life beneficial bacteria, can be integrated into the skincare routine—particularly when retinol, antibiotics, or benzoyl peroxide are used long term. These formulations help to rebalance microbial diversity, strengthen barrier function, and may provide relief from dryness and irritation. If a moisturiser is required, it should ideally maintain a slightly acidic pH in the range of 4.5 to 5.5, reinforce barrier lipids such as ceramides, squalane, and cholesterol, and avoid harsh antimicrobials or irritants. Incorporating prebiotics, probiotics, or postbiotics provides additional support for microbial balance, while gentle hydrating agents such as glycerin, hyaluronic acid, and panthenol improve comfort and barrier function. Importantly, products should be tested for microbiome safety to ensure compatibility with long-term skin health. We use a range of products at the clinic. Moisturisers for oily skin always remain among the most challenging to select, as patients often require hydration without heaviness or pore congestion. We find that HydroPeptide AquaBoost, an acne-friendly moisturiser, can also be considered microbiome-friendly.

 

Sun protection

SPF and the skin microbiome is an emerging area of research and product development. While photoprotection remains essential, it is important to recognise that high sun exposure is damaging not only for the skin itself but also for the balance of the skin microbiota. Mineral-based sunscreens are generally considered less disruptive to the microbiome compared with many chemical formulations. However, a number of commercial SPF products are formulated with a high pH, preservatives, or alcohol, all of which can negatively impact microbial diversity and skin barrier function. One way to mitigate these effects is to layer a microbiome-friendly product underneath sunscreen, chosen according to skin type. For oily or acne-prone skin, where the use of a moisturiser may be problematic, a mist or toner can provide a lighter alternative. We commonly recommend the Esse Mist range, while practitioners not familier with ESSE range can recommend HydraFlora Probiotic Toner from HydroPeptide product range which more widely available.  Otherwise, a microbiome-friendly mist or toner should be pH-balanced, free from harsh antimicrobials, alcohol, or synthetic fragrance, enriched with prebiotics, postbiotics, and humectants, and validated for microbiome compatibility.

 

Nutrition, supplementation and the gut–brain–skin axis

Topical approaches are only one part of the story. A microbiome-friendly diet also plays a central role in skin health via gut-skin axes pathway. Prebiotics, found in many types of vegetables, act as food for beneficial bacteria. By nourishing the microbiome, they help promote microbial diversity and reduce inflammation.⁸ Probiotics occur naturally in fermented foods such as kefir, sauerkraut, kimchi, and miso have beneficial effect for our gut microbiome.⁹ Probiotics can also be supplemented orally. At Hardwick Clinic, we use Dr. Ohhira’s Probiotics, which are manufactured using multi-year natural fermentation to provide a broad spectrum of beneficial strains.

Postbiotics are bioactive compounds produced when probiotics metabolise prebiotics. These include short-chain fatty acids, enzymes, peptides, and cell wall fragments. They have been shown to exert anti-inflammatory effects and support systemic health.¹⁰ By addressing gut health, we can further enhance the gut–skin microbiome axis, improving skin outcomes while contributing to overall wellbeing.

The gut–brain–skin axis links gut health, mental wellbeing, and skin function within a whole-body approach to health and longevity. Stress is a well-recognised modulator of both gut and skin microbiota, often worsening conditions such as acne, eczema, and rosacea. Stress management can be integrated into daily practice by signposting patients to accessible online resources or by creating a bank of personalised recommendations within the clinic to support individual patient needs.

---