Herbs, Nutrients & Probiotic Strains that May Assist

Lactobacillus acidophilus L-92^TM Postbiotic
Nicotinamide
Pyridoxal 5-phosphate monohydrate (Vitamin B6)
Colecalciferol (Vitamin D)
Zinc amino acid chelate
Ascorbic acid (Vitamin C)
D-α-tocopheryl acid succinate
Dry herbal extracts:
NutroxSun^TM – Consisting of:
Grapefruit
Citrus X paradisi
Rosemary
Rosmarinus officinalis

Actions

• Immunomodulatory and Gut-Immune Axis support
  
• Promotes Skin Repair
  
  • Boosts Skin Antioxidant Systems and Barrier Integrity
    
  • Dampens Skin Inflammation and Redness
    
  • Enhances Skin Elasticity

Clinical Applications

• Relieves the Symptoms of Mild Eczema and Dermatitis
  

Introduction

The skin is our body's frontline defence, protecting against harmful external factors, preventing water loss, and regulating temperature. However, poor nutrition, gut dysbiosis, UV radiation, and pollution can disrupt the immune system, generating reactive oxygen species (ROS) and inflammation.[3,4] These factors accelerate skin aging and damage the protective lipid barrier, increasing skin sensitivity and leading to skin conditions such as eczema and atopic dermatitis (AD) (Figure 1).[3,4]

To combat these issues, ingredients that modulate the immune system, eliminate ROS, reduce inflammation, and boost cellular antioxidant capacity are essential. Extensive research highlights the benefits of Lactobacillus acidophilus L-92™ Postbiotic (L-92™ ), a heat-treated probiotic known for its immune-modulating properties.[5–10] This postbiotic has been combined with Nutroxsun™, an extract of rosemary (Rosmarinus officinalis) and grapefruit (Citrus X paradisi) clinically trialled to demonstrate improvements in several aspects of skin health, including skin redness, inflammation, and elasticity.[11] Additionally, including vitamins D, C, E, B3, and zinc helps mitigate skin-damaging factors while elevating skin health (Figure 1).

Figure 1: Clinically trialled therapeutics attenuate sensitive skin, eczema and dermatitis.[3,4,7,8,11]

Background Information

Skin conditions are common worldwide, with 60-70% of women and 50-60% of men reporting sensitive skin.[3] Atopic skin conditions eczema and AD, often thought of as limited to childhood, can continue into later age, also presenting for the first time in older adults.[12]

Excessive ROS, generated by both internal and external stressors, adversely affect the condition and functioning of the skin, damaging components of the lipid matrix (such as sphingolipids, ceramides, and free fatty acids), which are part of the stratum corneum, also known as the skin barrier.[13] Early studies suggest a link between sensitive skin and a disrupted skin barrier. Furthermore, a weak skin barrier allows potential irritants to penetrate, facilitating access to antigen-presenting cells.[3] This, combined with a T-cell helper 2 (Th-2) immune dominance, supports the development of atopic skin conditions.[7,8] ROS also upregulates the activation of the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) pathway in keratinocytes.[13] This pathway is involved in the development of atopic skin conditions,[13] and induces pro-inflammatory cytokines,[11] which further increases ROS levels, leading to cellular DNA and protein oxidation,[14] whilst impairing skin repair and regeneration.

Improving skin conditions, such as dermatitis and sensitive skin, involves addressing several factors including attenuating ROS and inflammation, modulating immune responses, and increasing skin barrier integrity.

Actions

Immunomodulatory and Gut-Immune-Skin Axis

L-92™ has been extensively studied for its immunoregulatory properties, with numerous peer-reviewed studies demonstrating its efficacy.[7–10,15,16] L-92™ is reported to alleviate symptoms of Japanese Cedar pollen allergy, perennial allergic rhinitis, hay fever, and AD.[7–10,15,17] Observations show it modulates adaptive immunity by increasing levels of Transforming Growth Factor-β (TGF-β).[7,8] TGF-β plays a crucial role in the life cycle of T-cells, generating T-regulatory (Treg) cells, and regulating the differentiation and function of T-helper 1 (Th1) and Th2 cells.[18]

L-92™ has been reported to induce cell death in differentiated Th1 and Th2 cells after exposure to an antigen, with a greater degree of apoptosis in Th2 cells. Further, L-92™ enhances dendritic cell (DC) activity, leading to cell death in antigen-stimulated cells. These mechanisms assist in reducing T-cell hyper-responses.[9] Additionally, studies in humans have shown that L-92™ increases serum interleukin (IL) -12 levels,7,8 a Th1 immunoregulatory cytokine which may assist in lowering an excessive Th2 immune response.

L-92™ is believed to exert its immunomodulating effects through the gut-immune axis. It contains surface layer protein A (SlpA), which binds to and is engulfed by M cells in Peyer’s patches in the intestine. M cells present this information to DCs, releasing TGF-β and IL-12, and differentiating T-cells.[7]

L-92™ further influences immunity via its effect on the composition of the gut microbiome, whereby treatment with L-92™ significantly (p<0.01) lowered viable cell counts of Enterobacteriaceae and Clostridium, which have been linked with allergy conditions.[5] Additionally, L-92™ increased the abundance of Bacteroides spp. in the gut and enhanced intestinal immunoglobulin (Ig) A secretion.[19] Observations show Treg cells balance the microbiota by inducing IgA secretion, thus L-92™ may influence the gut microbiota composition by inducing Treg cells.[5]

The extensive body of research demonstrates that L-92™ exhibits significant immunoregulatory properties, particularly in modulating allergic responses, working through the gut-immune axis, and regulating T-cell immunity.

Promotes Skin Repair

Skin repair is an essential and tightly regulated process involving oxidative and inflammatory mechanisms and immune cell responses, reducing further tissue damage whilst maintaining barrier integrity.[4,20]

Boosts Skin Antioxidant Systems and Barrier Integrity

Antioxidants and antioxidant enzymes, including superoxide dismutase (SOD), catalase (CAT), and glutathione (GSH) play crucial roles in skin repair. ROS can overwhelm these systems, leading to more ROS and inflammation, impairing repair.[4]

Citrus bioflavonoids and rosemary constituents have proven ROS-scavenging capacity. Compounds like caffeic acid, rosmarinic acid, and carnosol from rosemary effectively neutralise superoxide radicals, and hydroxyl radicals, and prevent lipid peroxidation, reducing UV radiation damage.[11,14] Citrus bioflavonoids, like naringenin, enhance the survival of UVB-irradiated keratinocytes.[11,14] When combined, these extracts, as found in Nutroxsun™, provided even greater protection against UVB radiation than when used in isolation, demonstrating their synergistic effects.[14]

Vitamin C, vitamin E (d-α-tocopherol), vitamin B3 (nicotinamide), vitamin B6, and zinc offer anti-oxidant and anti-inflammatory benefits aiding skin repair.[21–26] Vitamin C helps form and maintain the skin barrier, reduces water loss, supports cell growth and differentiation, and maintains the functional activity of vitamin E, which is also imperative for skin health.[24,25] Interestingly, concentrations of α-tocopherol are higher in the epidermis compared with the dermis as vitamin E protects cell membranes and skin barrier lipids from oxidation.[25] Nicotinamide reduces ROS generation, lipid peroxidation, UVA and UVB-induced DNA damage, and cell death in skin cells exposed to environmental pollution.[22] Furthermore, nicotinamide strengthens the skin barrier by increasing the synthesis of essential lipids such as ceramides, free fatty acids, and cholesterol in human keratinocytes.[22] Zinc is abundant in the skin and vital for the survival of keratinocytes, aiding in repair and regulating inflammation.[23,24]

Dampens Skin Inflammation and Redness

The anti-inflammatory effects of rosemary terpenes, caffeic acid, and citrus flavanones and flavones, are linked to their antioxidant properties. ROS promote inflammation by activating the NF-κB pathway, increasing pro-inflammatory cytokines, and creating more ROS.[4,11] By scavenging these ROS, these compounds help reduce skin redness and inflammation, promoting skin repair.[11]

In a pilot randomised crossover study, five participants received Nutroxsun™, at doses of either 100 mg or 250 mg, or a placebo, 15-30 minutes before UVB exposure to one minimal erythemal dose (MED).[11] Two additional doses were given 24 and 48 hours after UV exposure. At 48 hours, a notable reduction (p=0.0252) was seen in the 100 mg group. By 72 hours, skin redness in both Nutroxsun™ groups had returned to pre-UVB exposure levels, and compared with placebo the reduction in skin redness for both Nutroxsun™ doses was statistically significant (100 mg group, p=0.020; 250 mg group, p=0.0182).

Building upon these results, a randomised parallel-group study with 90 participants investigated the effects of Nutroxsun™ on UVB-induced skin inflammation over a few months.[11] Participants were exposed to UVB radiation to 1 MED. They then commenced supplementation with either 100 mg or 250 mg doses of Nutroxsun™, or placebo daily for two months. At regular intervals during the trial period, participants continued to receive UVB radiation followed by researchers measuring levels of skin damage. The 100 mg dose effectively reduced skin redness after two weeks, one, and two months of treatment (p<0.001). The 250 mg dose provided similar results, with no statistical significance in results between the two doses (Figure 2). Highlighting the benefits of the 100 mg dose in attenuating skin redness and improving skin resilience.

Figure 2: Nutroxsun™ at 100 mg and 250 mg doses significantly increased MED after 0.5, 1, and 2 months of treatment.[11]

Furthermore, an increase in MED value after UV radiation exposure was observed in ten human volunteers prescribed Nutroxsun™.[14] After eight weeks of oral ingestion, a significant increase in MED was required to create skin redness (p<0.05), and at week 12 an even higher dose of MED was needed (p<0.01). The results show the benefits of Nutroxsun™ in reducing skin redness and inflammation, and that due to biological turnover, the skin requires several weeks to incorporate photoprotective nutrients effectively to boost skin antioxidant and anti-inflammatory defences.

Enhances Skin Elasticity

Skin elasticity is an important biomechanical indicator for assessing overall skin health, with a reduction in elastin leading to looser, sagging, and more fragile skin.[27,28] A study assessed the effect of Nutroxsun™ on skin elasticity and wrinkle depth in 90 participants over two months.[11] Researchers administered either 100 mg, 250 mg dose, or placebo daily with breakfast. R2 and R5 represent different dimensions of skin elasticity, where R2 is a measurement of overall skin elasticity, and R5 indicates the skin’s ability to recover from retraction.[27] Both doses experienced notable increases in both parameters of elasticity (Figure 3), with the greatest increase seen at the two-month mark. Interestingly there were no differences found between the doses, with the lower dose providing a greater increase in elasticity at the two-month mark.[11] Similarly, a significant decrease in wrinkle depth in the ‘Crows feet’ was seen with both doses over the two months, compared with placebo. Again, there was no significant difference in wrinkle depth between the 100 mg and 250 mg doses, suggesting a threshold effect at the lower dose.

Figure 3: Oral supplementation with Nutroxsun™ boosts skin elasticity.[11]

Clinical Applications

Relieves the Symptoms of Mild Eczema and Dermatitis

Atopic dermatitis (AD) is a chronically relapsing inflammatory skin disease marked by a weakened skin barrier and Th2-dominant immunity, leading to persistent itching and fragile skin.[7,8,20] Intestinal inflammation and compromised intestinal barrier function are reported in AD, along with an imbalance in the gut microbiome.[7,12]

L-92™ has shown promise in alleviating AD symptoms, such as spread, severity, and itching, and improving quality of life (QOL), alongside AD medication.[7,8] A randomised double-blind placebo-controlled trial examined the effects of L-92™, at 20.7 mg daily, against a placebo in patients with AD over eight weeks.[7] Researchers used the SCORing AD (SCORAD) index to evaluate changes in AD, tracking severity, spread, pruritus, and sleep quality, along with specific immune cells and cytokines. Participants continued taking their medications (corticosteroids and/or antihistamines) during the trial.

Post-trial, the L-92™ group had significantly lower SCORAD scores compared with the placebo group (p=0.002) (Figure 4). The eosinophil count was significantly decreased (p=0.03), with a greater change in serum TGF-β in the L-92™ group compared with the placebo group (p=0.03).[7]

Figure 4: L-92 significantly improves SCORAD scores over eight weeks.[7]

Building upon these results, another trial evaluated the effects of L-92™ on 57 patients with AD over six months. This randomised, double-blind, placebo-controlled trial administered 20.7 mg of L-92™ or placebo daily, in addition to prescribed AD medication.[8] The severity and progression of AD were evaluated using three indicators: Investigator Global Assessment (IGA), Eczema area and severity index (EASI), and SCORAD score.

Improvement was observed with the SCORAD score from eight weeks in the L-92™ group (p=0.02; Figure 5), suggesting a reduction in symptoms such as itching and sleep disturbances. From week 16, there was a notable improvement in the IGA (p=0.03), with a mean reduction of 33% seen in AD symptoms compared with no change in the placebo group. At the trial’s conclusion, at 24 weeks, there were marked improvements in all three AD scoring systems for eczema coverage, intensity, and impact on QOL (IGA – p<0.001, EASI – p=0.01, SCORAD – p<0.001). Improvements in AD evaluation indicators in the L-92™ group coincided with a significant elevation in TGF-β (p=0.03) by week 16, and IL-12 (p=0.049) by week 24, compared with the placebo group.

Figure 5: L-92™ provides significant improvements in SCORAD in patients with AD.[8]

In both studies, no adverse events occurred in participants taking L-92™ alongside AD medications. The effects of L-92™ in improving AD, as measured using the SCORAD score, were observed in both studies at eight weeks, with the second study demonstrating continued improvements until trial conclusion at 24 weeks.[7,8] Therefore, L-92™ may provide a safe and effective option for patients with AD.

Vitamin D plays a multifaceted role in skin health. It influences skin cell differentiation and growth, exhibits antimicrobial properties, and is involved in both innate and adaptive skin immunity.[29] Research has connected VD to atopic dermatitis (AD), with animal studies indicating symptom improvement following vitamin D serum (25(OH)D) replenishment through supplementation.[29] A systematic review and meta-analysis of 20 studies involving 1882 AD cases in both adults and children revealed significantly lower (p<0.001) 25(OH)D levels in AD patients compared to healthy controls.[29] Moreover, patients with severe AD had notably lower 25(OH)D levels (p<0.001) than those with moderate or mild AD. Several studies have shown that vitamin D supplementation, at doses ranging from 1000 IU to 2000 IU over two to three months, led to improvements in AD symptoms. Overall, vitamin D supplementation significantly improved (p<0.001) SCORAD scores over three months.

Safety Information

Disclaimer: In the interest of supporting health Practitioners, all safety information provided at the time of publishing (Jan 2025) is in accordance with Natural Medicine Database (NATMED PRO), renowned for its professional monographs which include a thorough assessment of safety, warnings, and adverse effects. For further information on specific interactions with health conditions and medications, refer to clinical support at 1800 777 648, or via email, anz_clinicalsupport@metagenics.com.

Pregnancy: Not recommended. Safety has not been conclusively established during pregnancy.[1,2]
Breastfeeding: Not recommended. Safety has not been conclusively established during breastfeeding.[1,2]

Cautions:

• The constituents found in grapefruit known as furanocoumarins, which include bergamottin and dihydroxybergamottin, are recognised to interact with several medications. The level of furanocoumarins present in NutroxSun™ is less than 10 ppm. For comparison, 250ml of grapefruit juice would be expected to deliver 12.84 mg of bergamottin.[30] Furanocoumarins from grapefruit juice inhibit several CYP enzymes involved in drug metabolism.[1] Therefore, practitioner discretion is advised when prescribing narrow therapeutic range medications, or those with possible toxic effects.
• Hypercalcemia - Vitamin D supplements may precipitate and worsen hypercalcemia.[31]
• Kidney disease - Vitamin D may increase calcium levels and increase the risk of arteriosclerosis in people with kidney failure. This must be balanced with the need to prevent renal osteodystrophy. Monitor calcium levels carefully.[31]
  
• Perioperative – Vitamin E might increase the risk of bleeding if used perioperatively. Discontinue supplementation at least 2 weeks prior to surgery.[32]
  
• Salicylate allergy - Rosemary contains salicylates. Individuals with salicylate allergy should use rosemary with caution.[2]

Contraindications:

• Angioplasty - There is some concern that vitamin B6 might increase the rate of restenosis after bare metal stent placement. Due to the potential for harm, B6 should not be recommended for patients receiving coronary stents.[33]
  
• Anticoagulant/antiplatelet drugs - Theoretically, drinking large amounts of grapefruit juice might increase the effects and adverse effects of warfarin.1 Using vitamin E with warfarin might increase the risk of bleeding.[32]
  
• Bleeding disorders - Theoretically, rosemary may prolong bleeding time and increase the risk of bruising and bleeding. In vitro and animal research shows that rosemary can inhibit platelet aggregation.[2] Theoretically, vitamin E might increase the risk of bleeding; until more is known, use vitamin E with caution in people with bleeding disorders.[32]
  
• Kidney Stones - Larger amounts of vitamin C can increase the risk of oxalate kidney stones, especially in those prone to oxalate stone formation. In males, daily supplemental vitamin C doses as low as 250 mg have been associated with a higher risk of kidney stones. Patients prone to kidney stone formation are advised to avoid higher doses of vitamin C.[34]
  
• Hypersensitive – Avoid in those with known hypersensitivity to rosemary, grapefruit, or citrus products.[1,2]

Prescribing tips and notes:

• Mild and infrequent gastrointestinal (GI) and skin reactions could occur in very sensitive individuals. Suggested to take with food to avoid unwanted GI symptoms.
  
• Antibiotics: It is advised to separate the administration of antibiotics and probiotic preparations by at least two hours.[35] Zinc may reduce levels of tetracycline antibiotics in the GI tract, therefore suggested to separate the dose by at least 2 hours.[36]
  

References

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[2] Natural Medicines Database. Rosemary. Published 2025. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=154#interactionsWithDiseases. Accessed January 30, 2025
[3] Farage MA. The prevalence of sensitive skin. Front Med. 2019;6:98. doi:10.3389/fmed.2019.00098
[4] Khan AQ, Agha MV, Sheikhan KSAM, Younis SM, Tamimi MA, Alam M, et al. Targeting deregulated oxidative stress in skin inflammatory diseases: An update on clinical importance. Biomed Pharmacother. 2022;154:113601. doi:10.1016/j.biopha.2022.113601
[5] Nakata J, Hirota T, Umemura H, Nakagawa T, Kando N, Futamura M, et al. Additive effect of Lactobacillus acidophilus L-92 on children with atopic dermatitis concomitant with food allergy. Asia Pac Allergy. 2019;9(2):e18. doi:10.5415/apallergy.2019.9.e18
[6] Goto H, Sagitani A, Ashida N, Kato S, Hirota T, Shinoda T, et al. Anti-influenza virus effects of both live and non-live Lactobacillus acidophilus L-92 accompanied by the activation of innate immunity. Brit J Nutr. 2013;110(10):1810-1818. doi:10.1017/s0007114513001104
[7] Inoue Y, Kambara T, Murata N, Komori-Yamaguchi J, Matsukura S, Takahashi Y, et al. Effects of oral administration of Lactobacillus acidophilus L-92 on the symptoms and serum cytokines of atopic dermatitis in Japanese adults: A double-blind, randomised, clinical trial. Int Arch Allergy Imm. 2015;165(4):247-254. doi:10.1159/000369806
[8] Yamamoto K, Yokoyama K, Matsukawa T, Kato S, Kato S, Yamada K, et al. Efficacy of prolonged ingestion of Lactobacillus acidophilus L-92 in adult patients with atopic dermatitis. J Dairy Sci. 2016;99(7):5039-5046. doi:10.3168/jds.2015-10605
[9] Kanzato H, Fujiwara S, Ise W, Kaminogawa S, Sato R, Hachimura S. Lactobacillus acidophilus strain L-92 induces apoptosis of antigen-stimulated T cells by modulating dendritic cell function. Immunobiology. 2008;213(5):399-408. doi:10.1016/j.imbio.2007.10.001
[10] Torii A, Torii S, Fujiwara S, Tanaka H, Inagaki N, Nagai H. Lactobacillus acidophilus strain L-92 regulates the production of Th1 cytokine as well as Th2 cytokines. Allergol Int. 2007;56(3):293-301. doi:10.2332/allergolint.o-06-459
[11] Nobile V, Michelotti A, Cestone E, Caturla N, Castillo J, Benavente-García O, et al. Skin photoprotective and antiageing effects of a combination of rosemary (Rosmarinus officinalis) and grapefruit (Citrus paradisi) polyphenols. Food Nutr Res. 2016;60(0):31871. doi:10.3402/fnr.v60.31871
[12] Li Y, Zhang B, Guo J, Cao Z, Shen M. The efficacy of probiotics supplementation for the treatment of atopic dermatitis in adults: a systematic review and meta-analysis. J Dermatol Treat. 2022;33(6):2800-2809. doi:10.1080/09546634.2022.2080170
[13] Michalak M. Plant-derived antioxidants: significance in skin health and the ageing process. Int J Mol Sci. 2022;23(2):585. doi:10.3390/ijms23020585
[14] Pérez-Sánchez A, Barrajón-Catalán E, Caturla N, Castillo J, Benavente-García O, Alcaraz M, et al. Protective effects of citrus and rosemary extracts on UV-induced damage in skin cell model and human volunteers. J Photochem Photobiol B: Biol. 2014;136:12-18. doi:10.1016/j.jphotobiol.2014.04.007
[15] Yanagihara S, Kanaya T, Fukuda S, Nakato G, Hanazato M, Wu XR, et al. Uromodulin–SlpA binding dictates Lactobacillus acidophilus uptake by intestinal epithelial M cells. Int Immunol. 2017;29(8):357-363. doi:10.1093/intimm/dxx043
[16] Ashida N, Yanagihara S, Shinoda T, Yamamoto N. Characterization of adhesive molecule with affinity to Caco-2 cells in Lactobacillus acidophilus by proteome analysis. J Biosci Bioeng. 2011;112(4):333-337. doi:10.1016/j.jbiosc.2011.06.001
[17] Ishida Y, Nakamura F, Kanzato H, Sawada D, Yamamoto N, Kagata H, et al. Effect of milk fermented with Lactobacillus acidophilus strain L-92 on symptoms of Japanese Cedar Pollen allergy: A randomised placebo-controlled trial. Biosci Biotechnology Biochem. 2005;69(9):1652-1660. doi:10.1271/bbb.69.1652
[18] Chen W. TGF-β Regulation of T cells. Annu Rev Immunol. 2023;(41):483-512. doi:10.1146/annurev-immunol-101921-045939.
[19] Sasai M, Kano C, Sakano K, Ishikawa S, Sawada D, Hirota T. Effect of oral intake of Lactobacillus acidophilus L-92 on systemic and intestinal immune parameters. Jap Phar Ther. 2022;50(9):1699-1707.
[20] Boothby IC, Cohen JN, Rosenblum MD. Regulatory T cells in skin injury: At the crossroads of tolerance and tissue repair. Sci Immunol. 2020;5(47). doi:10.1126/sciimmunol.aaz9631
[21] (NDA) EP on DPN and A. Scientific opinion on the substantiation of health claims related to vitamin C. Efsa J. 2009;7(10):1226. doi:10.2903/j.efsa.2009.1226
[22] Boo YC. Mechanistic basis and clinical evidence for the applications of nicotinamide (niacinamide) to control skin aging and pigmentation. Antioxidants. 2021;10(8):1315. doi:10.3390/antiox10081315
[23] Maywald M, Rink L. Zinc deficiency and zinc supplementation in allergic diseases. Biomolecules. 2024;14(7):863. doi:10.3390/biom14070863
[24] Michalak M, Pierzak M, Kręcisz B, Suliga E. Bioactive compounds for skin health: A review. Nutrients. 2021;13(1):203. doi:10.3390/nu13010203
[25] Dattola A, Silvestri M, Bennardo L, Passante M, Scali E, Patruno C, et al. Role of vitamins in skin health: a systematic review. Curr Nutrition Reports. 2020;9(3):226-235. doi:10.1007/s13668-020-00322-4
[26] Elgharably N, Abadie MA, Abadie MA, Ball P, morrissey hana. Vitamin B group levels and supplementations in dermatology: Review of the literature. Dermatol Rep. 2022;15(1):9511. doi:10.4081/dr.2022.9511
[27] Chen D, Yin S, Lu X, Fu H, Gao H, Zhang S. Research on the correlation between skin elasticity evaluation parameters and age. Cosmetics. 2024;11(6):205. doi:10.3390/cosmetics11060205
[28] Baumann L, Bernstein EF, Weiss AS, Bates D, Humphrey S, Silberberg M, et al. Clinical relevance of elastin in the structure and function of skin. Aesthetic Surg J Open Forum. 2021;3(3):ojab019. doi:10.1093/asjof/ojab019
[29] Ng JC, Yew YW. Effect of vitamin D serum levels and supplementation on Atopic Dermatitis: A systematic review and meta-analysis. Am J Clin Dermatol. 2022;23(3):267-275. doi:10.1007/s40257-022-00677-0
[30] Kawaguchi‐Suzuki M, Nasiri‐Kenari N, Shuster J, Jr. FGG, Cancalon P, Oliveria F de, et al. Effect of low‐furanocoumarin hybrid grapefruit juice consumption on midazolam pharmacokinetics. J Clin Pharmacol. 2017;57(3):305-311. doi:10.1002/jcph.807
[31] Database NM. Vitamin D. Published 2025. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=929#warnings. Accessed January 30, 2025
[32] Database NM. Vitamin E. Published 2025. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=954#interactionsWithDiseases. Accessed January 30, 2025
[33] Database NM. Vitamin B6. Published 2025. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=934#interactionsWithDiseases. Accessed January 30, 2025
[34] Database NM. Vitamin C. Published 2025. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=1001#interactionsWithDiseases. Accessed January 30, 2025
[35] Database NM. Lactobacillus acidophilus. Published 2025. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=790#interactionsWithDrugs. Accessed January 30, 2025
[36] Database NM. Zinc. Published 2025. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=982#interactionsWithDrugs. Accessed January 30, 2025