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Probiotics in the Treatment of Atopic Dermatitis

Question

Are probiotics helpful in the treatment and the prevention of atopic dermatitis?

Response:

Atopic dermatitis is one of the epidemically expanding non-infectious diseases in the 21 century. It poses immense challenges to both patients and physicians. With a steady growth in its incidence and prevalence, the disease carries a heavy social and economic burden.

Atopic dermatitis (AD, syn. ‘atopic eczema’) is the commonest inflammatory skin disorder in children and represents a serious problem for the providers of health care all over the world (1-4) with an impressive effect on patients' quality of life (1),(5-9). In 40–60% of paediatric patients with AD persist having symptoms later on in life (10, 11). Although AD often starts in early infancy, there are adult onset forms  which start in adolescence or adulthood (11). Most of the patients with AD can control their skin disease with topical therapy and emollient skin care. There is a considerable group of patients with severe AD who do not respond to the prescribed treatment with moisturizers, topical corticosteroids (TCS), and/or topical calcineurin inhibitors (TCI) or experience immediate flare-ups after tapering topical anti-inflammatory therapy.

Probiotics and prebiotics appear to be effective in reducing the incidence of atopic dermatitis in infants, but their role in atopic dermatitis treatment is controversial (13). The clinical research supporting the use of probiotics for the treatment and prevention of AD are very limited. The positive effect may be related to the type of probiotic strain used, the method of administration, onset time, as well as the dose size and duration of treatment (12).  Based on current systematic review evidence, the most promising intervention for the prevention of AE is the use of probiotics (and possibly prebiotics) during the late stages of pregnancy and early life (14-15).

Most of the conducted studies concluded that the incidence of AD was lower in the probiotic administered cases than the controls. They reported less episodes of AD in the infants of mothers who received any of the probiotic supplements compared to the placebo group; however, there was no difference in skin prick tests among the experimental groups (16).

There is no reliable evidence to date that strongly supports their safe application of probiotics.  In spite of the weak evidence, a considerable number of clinicians prescribe the use of probiotics for the prevention of eczema (18). 

AD is a multi-factor disease that requests personalized approach. The step-wise model with regard to the disease severity provides a practical algorithm to the disease management. Patient and parent therapeutic education represent an important element of the treatment plan. The future of AD treatment belongs to novel biological therapeutic agents coming in the recent years.  

References:

1. Carroll CL, Balkrishnan R, Feldman SR, Fleischer AB, Jr., Manuel JC. The burden of atopic dermatitis: impact on the patient, family, and society. Pediatr Dermatol. 2005;22(3):192-9.

2. Kemp AS. Cost of illness of atopic dermatitis in children: a societal perspective. Pharmacoeconomics. 2003;21(2):105-13.

3. Mancini AJ, Kaulback K, Chamlin SL. The socioeconomic impact of atopic dermatitis in the United States: a systematic review. Pediatr Dermatol. 2008;25(1):1-6.

4. Verboom P, Hakkaart-Van L, Sturkenboom M, De Zeeuw R, Menke H, Rutten F. The cost of atopic dermatitis in the Netherlands: an international comparison. Br J Dermatol. 2002;147(4):716-24.

5. Flohr C. Recent perspectives on the global epidemiology of childhood eczema. Allergol Immunopathol (Madr).39(3):174-82.

6. Arnold RJ, Donnelly A, Altieri L, Wong KS, Sung J. Assessment of outcomes and parental effect on Quality-of-Life endpoints in the management of atopic dermatitis. Manag Care Interface. 2007;20(2):18-23.

7. Lewis-Jones S. Quality of life and childhood atopic dermatitis: the misery of living with childhood eczema. Int J Clin Pract. 2006;60(8):984-92.

8. Meltzer LJ, Moore M. Sleep disruptions in parents of children and adolescents with chronic illnesses: prevalence, causes, and consequences. J Pediatr Psychol. 2008;33(3):279-91.

9. Weisshaar E, Diepgen TL, Bruckner T, Fartasch M, Kupfer J, Lob-Corzilius T, et al. Itch intensity evaluated in the German Atopic Dermatitis Intervention Study (GADIS): correlations with quality of life, coping behaviour and SCORAD severity in 823 children. Acta Derm Venereol. 2008;88(3):234-9.

10. Wuthrich B. Clinical aspects, epidemiology, and prognosis of atopic dermatitis. Ann Allergy Asthma Immunol. 1999;83(5):464-70.

11. Garmhausen D, Hagemann T, Bieber T, Dimitriou I, Fimmers R, Diepgen T, et al. Characterization of different courses of atopic dermatitis in adolescent and adult patients. Allergy.68(4):498-506.

12. Allen S. J., Jordan S., Storey M., Thornton C. A., Gravenor M. B., Garaiova I., et al. Probiotics in the prevention of eczema: a randomised controlled trial. Arch. Dis. Child. 99. 2014.  1014–1019.

13. Baquerizo Nole KL , Yim E , Keri JE. Probiotics and prebiotics in dermatology. J Am Acad Dermatol. 2014;71 (4):814- 21

14. Kalliomaki M, Salminen S, Poussa T, Arvilommi H, Isolauri E. Probiotics and prevention of atopic disease. 4-year follow-up of a randomized placebo-controlled trial. Lancet 2003;361:1869e71.

15. Kalliomaki M, Salminen S, Poussa T, Isolauri E. Probiotics during the first 7 years of life: a cumulative risk reduction of eczema in a randomized, placebo-controlled trial. J Allergy Clin Immunol 2007;119:101

16. Lee J, Seto D, Bielory L. Meta-analysis of clinical trials of probiotics for prevention and treatment of pediatric atopic dermatitis. J Allergy Clin Immunol 2008;121:116

17. Barclay L. Benefits of probiotics reviewed. Am Fam Physician 2008;78:107

18. Rather IA, Bajpai VK, Kumar S, Lim J, Paek WK, Park Y-H. Probiotics and Atopic Dermatitis: An Overview. Frontiers in Microbiology. 2016;7:507

 

Denica Zheleva
Tokuda Hospital Sofia
Dermatologic Clinic Sofia
Sofia, Bulgaria