Topical Probiotics Research Articles

Topical probiotics and steroids can accelerate the process of angiogenesis in wound repair: A comparative study in rats.

Objective: To asses if Topical probiotics and steroids can accelerate the process of angiogenesis in wound repair. Study Design: Longitudinal Experimental study. Setting: Al-Tibri Medical College. Period: Jan 2020 to Dec 2020. Material & Methods: Total 72 male albino rats were acquired from the animal house of the institution, and 18 as a requirement of per day of sampling included 6 animals/gp. An equal size incision of (2x2cm2) was made in all the animals. Group A was given Topical Normal Saline (Control Group), Group B was given the Probiotic (Lactobacillus Acidophilus), and Group C was given Topical Steroid (Dexamethasone). Samples from the wound created surgically was obtained on the 3rd, 7th, 14th, and 21st Day and slides were created to observe the number of blood vessels formed and angiogenesis under a light microscope. Data was analyzed using SPSS version 21.0. To compare the mean between the groups, the ANOVA was applied along with post hoc Tukey's test. The level of significance was considered P≤0.05. Results: The mean number of blood vessels formed in Group A (Control Group) was 2.75, 4, 5.25, and 5.50, in Group B (Probiotics Group) was 10, 13.50, 2.25, and 1, and in Group C (Steroid Group) was 3.75, 5.50, 3, and 2.25 on the 3rd, 7th, 14th, and 21st Day respectively. Significant difference was seen in the mean number of blood vessels formed when the Probiotic group was compared to Group A and C. Conclusion: Topical Probiotic accelerates the process of angiogenesis in wound repair due to their anti-inflammatory response.

Topical prebiotics/postbiotics and PRURISCORE validation in atopic dermatitis. International study of 396 patients

Aim: To investigate the efficacy and tolerability of a cream (Rilastil Xerolact PB) containing a mixture of prebiotics and postbiotics, and to validate the PRURISCORE itch scale in the management of atopic dermatitis.Methods: The study is based on 396 subjects of both sexes in three age groups (i.e., infants, children, adults) suffering from mild/moderate Atopic Dermatitis, recruited from 8 European countries and followed for 3 months.Results: The product demonstrated good efficacy combined with good/very good tolerability in all age groups. In particular, SCORAD, PRURISCORE and IGA scores decreased significantly over the course of the study. The PRURISCORE was preferred to VAS by the vast majority of patients.Conclusion: Even though the role of prebiotics and postbiotics was not formally demonstrated since these substances were part of a complex formulation, it can be reasonably stated that prebiotics and postbiotics have safety and standardization features that probiotics do not have. In addition they are authorized by regulatory authorities, whereas topical probiotics are not.

Acne, Microbiome, and Probiotics: The Gut-Skin Axis.

The objective of this narrative review was to check the influence of the human microbiota in the pathogenesis of acne and how the treatment with probiotics as adjuvant or alternative therapy affects the evolution of acne vulgaris. Acne is a chronic inflammatory skin disease involving the pilosebaceous units. The pathogenesis of acne is complex and multifactorial involving genetic, metabolic, and hormonal factors in which both skin and gut microbiota are implicated. Numerous studies have shown the bidirectionality between the intestinal microbiota and skin homeostasis, a communication mainly established by modifying the immune system. Increased data on the mechanisms of action regarding the relevance of Cutibacterium acnes, as well as the importance of the gut–skin axis, are becoming known. Diverse and varied in vitro studies have shown the potential beneficial effects of probiotics in this context. Clinical trials with both topical and oral probiotics are scarce, although they have shown positive results, especially with oral probiotics through the modulation of the intestinal microbiota, generating an anti-inflammatory response and restoring intestinal integrity, or through metabolic pathways involving insulin-like growth factor I (IGF-1). Given the aggressiveness of some standard acne treatments, probiotics should continue to be investigated as an alternative or adjuvant therapy.

Dental Practitioners’ Knowledge, Attitude, and Practice in Caries Risk Assessment and Management: A Cross-sectional Survey in Kampala Metropolitan, Uganda

The objective of this study was to determine the knowledge, attitude, and practices regarding caries risk assessment (CRA) and management among dental practitioners in Kampala Metropolitan, Uganda. This cross-sectional study was conducted among 270 dental practitioners in Kampala Metropolitan, Uganda, in May 2021. The participants were dental surgeons and public health dental officers. A self-administered structured questionnaire was used to collect data. The questionnaire included items about participants' sociodemographic characteristics, knowledge, attitude, and practices in CRA and management. Attitude and practices were rated using different Likert scales. Descriptive statistics, Chi-square/Fisher's exact and one-way analysis of variance (ANOVA) with post-hoc Bonferroni tests were used to analyze the data. The significance level was set at p <0.05. About 60.7% of the participants were public health dental officers with a median age of 30 years (interquartile range [IQR], 27-60). Overall, the participants were familiar with the current concepts regarding CRA and management. More than 70% of the participants correctly identified risk factors and indicators of dental caries. Most participants (98.5%) had a positive attitude toward performing CRA. However, their practices regarding caries management were inadequate as majority (>75%) of participants reported that they never or occasionally recommended evidence-based products like topical fluoride, probiotics, or xylitol products in the prevention and management of dental caries. Dental surgeons had significantly better knowledge and practices than public health dental officers (p <0.05). In the present study, the participants were familiar with the current concepts about CRA and had a positive attitude toward CRA. However, their practices regarding caries prevention and management were inadequate. The study provided baseline data about knowledge, attitude, and practices regarding CRA and caries management among dental practitioners in Uganda. It is recommended to design training courses in evidence-based protocols in the prevention and management of dental caries for dental practitioners in Uganda.

Nasal administration of a probiotic assemblage in allergic rhinitis: A randomised placebo-controlled crossover trial.

BackgroundTopical probiotics have been suggested as a treatment option for allergic rhinitis, as they may skew the immune response towards a beneficial type‐1 non‐allergic profile. So far observations in man have exclusively involved oral intake. The aim of this study was to examine whether a topical/nasal administration of a probiotic assemblage (PA) affects quality of life, symptoms and signs of allergic rhinitis in a nasal allergen challenge (NAC) model.MethodsIn a placebo‐controlled and crossover design, 24 patients with seasonal allergic rhinitis were randomised to topical/nasal administration with a PA of Lactobacillus rhamnosus SP1, Lactobacillus paracasei 101/37 and Lactococcus lactis L1A or placebo for 3 weeks. Participants and investigators were blind to treatment allocation. The last week of each treatment period was combined with a NAC series. Efficacy variables were “Mini‐Rhinoconjunctivitis Quality of Life Questionnaire” (Mini‐RQLQ), “Total Nasal Symptom Score” (TNSS), “Peak Nasal Inspiratory Flow” (PNIF) and “Fractional Exhaled Nitric Oxide” (FeNO). In addition, to assess whether or not the PA produced any pro‐inflammatory effect per se, soluble analytes were monitored in nasal lavage fluids. Finally, bacterial cultures, sampled using swabs from the middle nasal meatus, were assessed for the presence of the PA by MALDI‐TOF analysis.ResultsAdministration of the PA did not produce any nasal symptoms (cf. placebo). An innate immune response was discerned within the PA run (cf. baseline), but no change in nasal lavage fluid levels of cytokines/mediators was observed cf. placebo except for IL‐17/IL‐17A (a minor increase in the PA run). Administration of the PA did neither affect Mini‐RQLQ, TNSS, PNIF nor FeNO. No evidence of persistent colonization was observed.ConclusionsTopical/nasal administration of a PA comprising Lactobacillus rhamnosus SP1, Lactobacillus paracasei 101/37 and Lactococcus lactis L1A, while likely evoking a minor innate immune response yet being safe, does not affect quality of life, symptoms or signs of allergic rhinitis. Trial registration: not registered.

Topical Probiotics: More Than a Skin Deep.

Skin, an exterior interface of the human body is home to commensal microbiota and also acts a physical barrier that protects from invasion of foreign pathogenic microorganisms. In recent years, interest has significantly expanded beyond the gut microbiome to include the skin microbiome and its influence in managing several skin disorders. Probiotics play a major role in maintaining human health and disease prevention. Topical probiotics have demonstrated beneficial effects for the treatment of certain inflammatory skin diseases such as acne, rosacea, psoriasis etc., and also found to have a promising role in wound healing. In this review, we discuss recent insights into applications of topical probiotics and their influence on health and diseases of the skin. Patents, commercially available topical probiotics, and novel probiotic impregnated fabrics have been emphasized. A thorough understanding of the relationship between probiotics and the skin microbiome is important for designing novel therapeutic approaches in using topical probiotics.

Antibiofilm effect of probiotic lactic acid bacteria against Bacillus spp obtained from the ocular surface.

Increasing emergence of antibiotic resistance has led to developing alternative methods to overcome this issue. The antibiotic resistance is mainly associated with formation of biofilms. Restoring healthy microbiota is one of these methods to fight the biofilm formation. In terms of this, the use of probiotics is a novel approach. In this study, we aimed at investigating the effect of exopolysaccharides (EPSs) of different lactic acid bacteria as probiotics on Bacillus spp isolated from the ocular surface, which is known to form biofilms. Pathogenic microorganisms were cultivated in "Brain-Hearth infusion" (BHI) broth, and lactic acid bacteria were grown in "De Man, Rogosa, Sharpe" and M17 broth. Molecular identification of lactic acid bacteria was made according to the sequence information of the 16S rRNA gene region. Antimicrobial activity of lactic acid bacteria was determined by sandwich overlay method. The minimum inhibitory concentration values of the exopolysaccharides and antibiofilm activity were determined by microtitration method. For evaluating the effect of EPSs of probiotic bacteria on biofilm, the mean and standard deviations of optical density values were calculated. The most effective EPS against B. cereus was EPS from L. rhamnosus 24, followed by EPS from L. plantarum and L. acidophilus. The biofilm formation of all pathogenic bacteria that were exposed to probiotic bacteria except L. rhamnosus 621 and 622 and L. rhamnosus 3111 was lower than the biofilm formation of the control group. EPSs obtained from lactic acid bacteria have antibacterial and antibiofilm activity on pathogenic bacteria isolated from ocular surface. This study is one of the pioneer studies in restoring healthy microbiota on ocular surface with the anticipated forthcoming use of topical probiotics.

Topical Probiotics Do Not Satisfy New Criteria for Effective Use Due to Insufficient Skin Microbiome Knowledge

We propose a set of criteria for topical probiotics to adhere to for safe and effective use for the skin microbiome. To form the basis of the criteria, we redefine the term “probiotics” and discuss successful and unsuccessful high-profile examples of the artificial addition of organisms to ecosystems in nature to understand what worked and what did not. Probiotics are often immediately assumed to have health benefits. However, as ecologists are aware, interfering with ecosystems is potentially catastrophic. The addition or removal of just one organism can significantly upset the delicate ecosystem balance. If our criteria are not met, we argue that topical probiotics could also cause damage and will not be beneficial. Due to the large intra- and inter-personal variation of the skin microbiome, our current knowledge of a healthy skin microbiome composition is not complete enough to fully satisfy the criteria. In follow-up work, we will investigate whether current topical probiotics research and commercial products meet our new criteria. We will also discuss problems with how to measure their effectiveness and suggest alternative solutions to replacing the lost biodiversity of the skin microbiome that was stripped away by environmental factors in the Western world.

A Journey on the Skin Microbiome: Pitfalls and Opportunities.

The human skin microbiota is essential for maintaining homeostasis and ensuring barrier functions. Over the years, the characterization of its composition and taxonomic diversity has reached outstanding goals, with more than 10 million bacterial genes collected and cataloged. Nevertheless, the study of the skin microbiota presents specific challenges that need to be addressed in study design. Benchmarking procedures and reproducible and robust analysis workflows for increasing comparability among studies are required. For various reasons and because of specific technical problems, these issues have been investigated in gut microbiota studies, but they have been largely overlooked for skin microbiota. After a short description of the skin microbiota, the review tackles methodological aspects and their pitfalls, covering NGS approaches and high throughput culture-based techniques. Recent insights into the “core” and “transient” types of skin microbiota and how the manipulation of these communities can prevent or combat skin diseases are also covered. Finally, this review includes an overview of the main dermatological diseases, the changes in the microbiota composition associated with them, and the recommended skin sampling procedures. The last section focuses on topical and oral probiotics to improve and maintain skin health, considering their possible applications for skin diseases.

Topical Probiotics for Women’s Urogenital Health: Selection of an Oil-based Carrier

Vaginal care products are widely used by women to relieve discomfort such as pain, itching and malodour, all of which are commonly caused by conditions resulting from microbiota dysbiosis. Previous studies showed that probiotic strains Lacticaseibacillus (formerly Lactobacillus) rhamnosus GR-1 (LGR-1) and Limosilactobacillus (formerly Lactobacillus) reuteri RC-14 (LRC-14), can aid in restoring homeostasis in the vaginal microbiome when taken orally. A topical product containing these strains could be of value for reducing malodour and improving quality of life. However, the formulation of such a product is a challenge, given that its ingredients must maintain shelf-life viability by excluding moisture. Here, we tested petroleum jelly, mineral oil, coconut oil, and olive oil for how well they maintained the viability of freeze-dried probiotic strains over a six-month timeframe. None of the oils caused excessive loss of bacterial viability, with petroleum jelly and coconut oil showing the most promise. Based on existing knowledge of these oils on the female genitalia, coconut oil and petroleum jelly could be suitable probiotic carriers for clinical testing.

Lactic acid bacteria as probiotics for the nose?

SummarySeveral studies have recently pointed towards an increased occurrence and prevalence of several taxa of the lactic acid bacteria (LAB) in the microbiota of the upper respiratory tract (URT) under healthy conditions versus disease. These include several species of the Lactobacillales such as Lacticaseibacillus casei, Lactococcus lactis and Dolosigranulum pigrum. In addition to physiological studies on their potential beneficial functions and their long history of safe use as probiotics in other human body sites, LAB are thus increasingly to be explored as alternative or complementary treatment for URT diseases. This review highlights the importance of lactic acid bacteria in the respiratory tract and their potential as topical probiotics for this body site. We focus on the potential probiotic properties and adaptation factors that are needed for a bacterial strain to optimally exert its beneficial activity in the respiratory tract. Furthermore, we discuss a range of in silico, in vitro and in vivo models needed to obtain better insights into the efficacy and adaptation factors specifically for URT probiotics. Such knowledge will facilitate optimal strain selection in order to conduct rigorous clinical studies with the most suitable probiotic strains. Despite convincing evidence from microbiome association and in vitro studies, the clinical evidence for oral or topical probiotics for common URT diseases such as chronic rhinosinusitis (CRS) needs further substantiation.

Topical cream containing live lactobacilli decreases malodor-producing bacteria and downregulates genes encoding PLP-dependent enzymes on the axillary skin microbiome of healthy adult Nigerians.

Clinical data exist that support the utility of topical probiotics for certain dermatological diseases such as atopic dermatitis, acne, and psoriasis. However, there is paucity of data on the use of live lactobacilli to control axillary malodor. The objective of this study was to determine whether application of topical oil-based cream containing live Lactobacilli could decrease malodor-producing bacteria in the axilla of healthy subjects. To determine the effects of topical cream with live lactobacilli on malodor-producing bacteria in the axilla of healthy subjects. Twenty-five adult volunteers comprising 12 males and 13 females provided informed consent. Axillary skin swabs were collected before and after 14days application of topical cream containing live Lactobacillus pentosus KCA1. Bacterial DNA was extracted, and V4 region of the 16S rRNA was amplified and sequenced in a pair-end configuration on the Illumina MiSeq platform rendering 2×150bp sequences. Microbial taxonomy to species level was generated using the Greengenes database. Linear discriminant analysis (LDA) effect size (LEfSe) was used to identify biologically and statistically significant differences in relative abundance. Actinobacteria decreased from 70% to 24%, and Firmicutes increased from 26.6% to 73.9% among the female participants. In males, Actinobacteria decreased from 65% to 38%, while Firmicutes increased from 24% to 57%. Corynebacterium decreased from 62.91% to 36.63%, while Lactobacillus increased from 0.06% to 23.11%. In males, unliked females, there were reduction of Staphylococcus species associated with malodor, notably Staphylococcus hominis, Staphylococcus hemolyticus, and Staphylococcus lugdunensis. Bacterial functional gene- Pyridoxal protein dependent enzymes involved in biotransformation of malodor precursor to volatile thioalcohols were down-regulated. Application of Lactobacillus pentosus KCA1 cream led to a significant decrease in the relative abundance of odor-producing Corynebacterium species in both female and male subjects. Some species associated with malodor especially Corynebacterium striatum, Corynebacterium jeikeium, Corynebacterium tuberculostearicum, and Staphylococcus hominis decreased by 96%, 73%, 7%, and 20.8%, respectively, in males.

Topical Probiotics in Dermatological Therapy and Skincare: A Concise Review.

Recent studies have produced an increasing body of evidence that the intestinal microbiome plays an essential role in modulating systemic inflammation and skin diseases. The gut microbiome influences and modulates the host immune system, enabling immune tolerance of environmental and dietary antigens and protecting against pathogens. Emerging scientific evidence has demonstrated that oral probiotics can help treat certain skin diseases, such as acne, atopic dermatitis, photoaging, psoriasis, and wound healing. The aim of this paper is to review the current scientific evidence on topical probiotics and their effects on dermatological diseases and skincare and to clarify if the application of exogenous probiotics could also have the same benefit as oral probiotics in promoting positive bacterial balance to treat dermatologic conditions.

The role of topical probiotics on wound healing: A review of animal and human studies.

Pathogenic, opportunistic, and commensal bacterial coexist in the intestinal tract, and imbalances among these strains have been linked to systemic inflammation and a variety of disease states. Similarly, human skin plays an important role as an interface between the body and the environment with an estimated 1 billion microbes per square centimetres. Skin microbiome fluctuations that cause increases in pathologic bacteria, either because of individual and/or environmental factors, can lead to disease states at the skin level ranging from inflammatory conditions to infections. As wounds are inherently associated with perturbations in the local microflora due to injury and activation of the immune responses, the addition of topical probiotics could be a means to prevent infection, regulate inflammation, and potentially augment healing. The goal of this review is to analyse the impact the skin microbiome has on cutaneous wound healing with a focus on developing proposed treatment algorithms and support for their therapeutic potential.

The evaluation of the effect of probiotics on the healing of equine distal limb wounds

The effect of dressings saturated with either a standardized suspension of probiotic bacteria or saline on healing of traumatic distal limb wounds in horses was evaluated for 24 days, and the systemic inflammatory effect was assessed. The wounds were divided in two groups based on the phase of healing: wounds with an incomplete (ICGB) or a complete granulation bed (CGB). The wound area was expressed as percentage of the wound area at day 0 and defined as relative wound area. The mean relative wound area decreased faster in probiotic than saline treated wounds. The difference was most obvious in CGB and increased rapidly from day 0 until day 12 up to 30%, and stabilized around 25% thereafter until the end of the observation period, but it was not statistically significant because of the large variation within the treatment groups. The mean wound area of CGB decreased to 28.4% (range: 6.3 to 49.3) with probiotic and to 51.9% (range: 29.3 to 81.7) with saline treatment at day 24. Additionally, the rate to 50% healing in CGB was 3.4 faster with probiotic compared to saline treatment, whereas in ICGB this was 1.9 faster. Topical probiotics did not increase serum amyloid A and white blood cell counts. Although the mentioned differences were not statistically significant, the clinical relevance of the effect of treatment with probiotics in CGB wounds is clear, supported by the differences in mean wound area in course of time and the time required to reach 50% healing (day 12 for probiotic vs more than day 24 for saline treated wounds). Thus the probiotic treated wounds reached 50% reduction in wound area in half of the time of the saline treated wounds. The topical use of probiotics can be considered as safe as it did not cause a systemic effect.

Acne treatments: future trajectories.

Current acne treatments present several limitations, posing the need for new effective therapies for long-term administration for recalcitrant or relapsing acne. Key players in acne that may emerge as targets for future acne treatments include the cutaneous loss of diversity of Cutibacterium (formerly Propionibacterium) acnes phylotypes and the insulin-like growth factor-1 signalling pathway. New data about the loss of diversity of microbiota in acne provides the rationale for the potential use of oral or topical probiotics. Another therapeutic approach to modulate the microbiota could be topical formulation of C.acnes bacteriophages to target specifically the pathogenic 'acnegenic' C.acnes phylotypes. Insulin-sensitizing agents such as metformin, myo-inositol and d-chiro-inositol represent promising agents, but to date there have been only limited studies and much heterogeneity in the methods of assessing acne efficacy outcomes. Moving towards a holistic approach for patients with acne is the future, by taking into account both internal and external factors, such as pollution, stress, acne family history, age, smoking habits and diet, and addressing quality of life and the psychological impact of acne.

The role of topical probiotics in skin conditions: A systematic review of animal and human studies and implications for future therapies.

There is increasing evidence that the intestinal microbiome plays an important role in modulating systemic inflammation and disease. Oral probiotics can modulate the intestinal microbiome and have demonstrated to be efficacious in treating topical skin conditions, such as atopic dermatitis, acne and rosacea. By proxy, exogenous application to the skin of probiotics should also promote a positive bacterial balance to mitigate or potentially eliminate pathologic conditions. The goal of this article was to provide a systematic review of studies that have investigated the role of topical probiotics in mitigating skin conditions. Additionally, skin conditions where dysbiosis has been identified but topical probiotics have not been investigated are discussed. We hope this review both analyses the evidence for the role that topical probiotics could play in topical skin conditions and highlights additional areas in need of research and exploration.

Changing our microbiome: probiotics in dermatology.

Commensal bacteria are a major factor in human health and disease pathogenesis. Interest has recently expanded beyond the gastrointestinal microbiome to include the skin microbiome and its impact on various skin diseases. Here we present current data reviewing the role of the microbiome in dermatology, considering both the gut and skin microflora. Our objective was to evaluate whether the clinical data support the utility of oral and topical probiotics for certain dermatological diseases. The PubMed and ClinicalTrials.gov databases were searched for basic science, translational research and clinical studies that investigated differences in the cutaneous microbiome and the impact of probiotics in patients with atopic dermatitis, acne vulgaris, psoriasis, chronic wounds, seborrhoeic dermatitis and cutaneous neoplasms. Few clinical trials exist that explore the utility of probiotics for the prevention and treatment of dermatological diseases, with the exception of atopic dermatitis. Most studies investigated oral probiotic interventions, and of those utilizing topical probiotics, few included skin commensals. In general, the available clinical trials yielded positive results with improvement of the skin conditions after probiotic intervention. Oral and topical probiotics appear to be effective for the treatment of certain inflammatory skin diseases and demonstrate a promising role in wound healing and skin cancer. However, more studies are needed to confirm these results. What's already known about this topic? The microbiome plays a role in human health and disease pathogenesis. Probiotics can manipulate the host microbiome and may confer health benefits for patients. Research to date has already begun to explore the utility of oral and topical probiotics for certain dermatological diseases. What does this study add? This review presents basic science and clinical trial data to support the role of the gut and skin microbiome in dermatology. Current data are reviewed on the use of probiotics in the prevention and treatment of skin diseases, including atopic dermatitis, acne vulgaris, psoriasis, seborrhoeic dermatitis, chronic wounds and cutaneous neoplasms. Future probiotic interventions are proposed.

Topical probiotics: the unknowns behind their rising popularity

Topical probiotics have been used for skin care and treatment since the early 20th century. Over the past decade, there has been a dramatic surge of commercially-available topical probiotic products. We conducted a systematic search of clinical data relating to the use of topical probiotics and identified relevant clinical and regulatory gaps. PubMed and Google Scholar searches were conducted for trials and reviews of probiotics. FDA definitions of cosmetics, drugs, and regulation of topical probiotics were reviewed. Topical probiotics have shown efficacy in a number of limited trials, particularly those involving the treatment of acne, atopic dermatitis, and rosacea. However, there is a paucity of literature on the safety profiles, mechanistic action, and therapeutic potential of topical probiotic products. Several regulatory gaps exist, including approval and classification of topical probiotic products by the FDA; currently there are no topical probiotic products the FDA has approved as drugs. With increasing popularity among the general public, but insufficient clinical data to demonstrate large-scale effectiveness and a thorough understanding of side effects, there is a need for further mechanistic and clinical investigation, as well as improved regulation and standardization of topical probiotic products.

Localized Necrotic Ulceration Gingivitis, in Orthodontic Patient, Treated with Non- Surgical Periodontal Therapy and with Probiotics (L. Reuteri)

Acute Necrotic Ulcerative Gingivitis constitute a group of aggressive semi-reversible periodontal disease usually linked to deep microbiome alterations (Treponema sp., B. melaninogenicus ssp. intermedius and the Fusobacterium sp) and difficult plaque removal. Patients undergoing in fixed orthodontic treatment could have higher risk in periodontal/gum disease development. Therapy for resilient and resistant ANUG is usually represented by pocket debridement and additional systemic therapies (often Metronidazole). In recent years patients resistance to antimicrobial therapies has strongly increased, so probiotic represent a new incoming approach in non surgical periodontal diseases treatment. The aim of this work is to report a case of orthodontic patient with refractory ANUG successfully treated with topical probiotic L. Reuteri. A 16-year-old female with a necrotic ulceration gingivitis reported to our private practice. The patient was submitted to local antiseptics and periodontal debridement for several months without improvement. We had decided to associate a treatment with topical probiotics Lactobacillus reuteri DSM 17938 and lactobacillus reuteri ATCC PTA 5289 to the non-surgical periodontal therapy. The solution of probiotic was injected into the pockets until the spill, for 3-5 minutes and at the end the patient did not rinse the mouth and was advised not to eat and drink for about an hour. The use of topical probiotics in the treatment of gingivitis and ANUG could be considered a valid alternative to conventional treatments for refractory cases in orthodontic patients. Further studies, especially randomized clinical trials, must be performed to confirm this starting result.