Major clinical outcomes of the gut microbiota-skin axis through exosomes and probiotics: a systematic review

Introduction: Skin diseases have contributed significantly to the increasing burden of disease and injury in recent years, and the gut microbiota, probiotics, and exosomes contribute to reducing this burden. These vesicles have emerged as a focus of fundamental research in regenerative medicine. Exosomes participate in intercellular communication, tissue repair, and disease pathogenesis. Objective: The study analyzed the main scientific evidence on the relationship between gut microbiota and skin, emphasizing the importance of intestinal health through probiotics and exosomes for aesthetically healthy skin. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from May to July 2025 in the Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 122 articles were found, 52 of which were fully evaluated, and 23 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in seven studies with a high risk of bias and 20 studies that did not meet GRADE and AMSTAR-2 criteria. Most studies showed homogeneity in their results, with X2=88.9%>50%. It was concluded that exosomes and the gut microbiota directly impact skin regenerative processes. Despite the challenges, their complexity and versatility reinforce their potential in the development of personalized strategies for skin health. To establish aesthetically healthy skin, it is imperative to manipulate the gut microbiota to achieve balance. Therefore, treatments that elevate or repair the gut are essential as adjunctive therapy in the management of inflammatory skin diseases and may contribute to the effectiveness of standard dermatotherapy.