ATOPIC DERMATITIS (ECZEMA) AND PROBIOTICS

By Jacqueline Wivinus and Kristina Hegarty

“EFFECT OF PROBIOTICS ON THE TREATMENT OF CHILDREN WITH ATOPIC DERMATITIS”

Objective: To study the effects of the use of probiotics in pediatric patients that suffer from atopic dermatitis.

Clinical Significance: Intestinal permeability and dysbiosis influence gut immune

function GI permeability is thought to be greatest in early infancy and to

decline with intestinal maturation. GI permeability and microbiota are thought to be critical influences in allergic disease. 1

Probiotics compete with pathogens Probiotics alleviate immunogenicity of potential allergens

METHODS

Double-blind randomized, placebo-controlled study Pediatric patients: 1-13 yo Probiotic complex

Bifidobacterium bifidum Lactobacillus acidophilus Lactobacillus casei Lactobacillus salivarius

Placebo control group Skim milk powder dextrose

RESULTS

RESULTS

LIMITATIONS

Strengths Randomized, double-blind, controlled trial Statistically significant results Measuring multiple inflammatory markers

Weaknesses Skim milk placebo Small sample size Limited to pediatric patients Duration SCORAD subjectivity

DATABASE REVIEW

The Cochrane Database 12 randomized controlled trials reviewed No significant improvement with probiotics

Up to Date Database Meta-analyses of using probiotics for

eczema treatment Problems of quality with some studies and

heterogeneity Probiotics benefit IgE sensitized individuals

DATABASE REVIEW

Natural Standard Probiotics for children is promising Infants benefit from mothers probiotics use May reduce cow’s milk allergy and other

allergic reactions Stabilize intestinal barrier function

RECOMMENDED TREATMENT STRATEGIES Probiotic supplementation Limit/avoid stress Skin or serum testing Elimination diet

REFERENCES

Mahan L, Escott-Stump S, Raymond J. Krause’s Food and the Nutrition Care Process. St. Louis, Missouri: Elsevier Inc; 2012.

Yesilova Y, Calka O, Akdeniz N, Berktas M. Effect of Probiotics on the Treatment of Children with Atopic Dermatitis. Ann Dermatol. 2012; 24: 189-193.

Boyle, RJ, Bath-Hextall, FJ, Leonardi-Bee, J, Murrell, DF, Tang, MLK. Probiotics for treating eczema (Review). Wiley [serial online]. 2008; 4: 1-57. Available from: The Cochrane Library. Accessed June 1, 2012.

West, C, Prescott, S. Prebiotics and probiotics for treatment of allergic disease. Wolters Kluwer Health [serial online]. 2011. Available from: UpToDate. Accessed June 1, 2012.

Natural Standard. Probiotics (Bifidobacterium, Lactobacillus, Saccharomyces boulardii) page. Available at: http://www.naturalstandard.com/databases/ herbssupplements/patient-probiotics.asp#. Accessed May 30, 2012.