It is great to see this article in the “mainstream” American dermatology literature because it raises awareness of a practical, useful treatment strategy that dermatologists should incorporate into their practices immediately.  It is extremely inexpensive, completely safe, and parents (and adult patients) love having something “natural” to do.  There have been almost 20 articles published about probiotics and atopic dermatitis starting almost 15 years ago, but almost no dermatologists are aware of this literature.  In fact, I believe we’ve reached the point in this literature where further trials showing probiotics work aren’t really helpful.  What would be helpful are randomized comparative trials comparing various commercially available strains or combinations of strains.

So, what to do with this study and the probiotics in atopic dermatitis literature in general.  First, in terms of disclaimer, it is a difficult literature to decide what to do with.  Most of the articles show that probiotics do something, either in reducing the severity of ongoing atopic dermatitis or to prevent atopic dermatitis if given to a pregnant female who is at high risk for having a child with atopic dermatitis.  However, the results aren’t dramatic and it is generally impossible to get a probiotic that is identical to the one used in any given trial.

If probiotics were expensive or risky, I’d say we need to wait for better info before we implement in practice.  However, given that they are cheap and safe and we have decent evidence that they probably do something, I’ve been using them for years.  Based on the strains it contains and price, I recommend this probiotic: NOW Probiotic-10, 25 billion.  It is available on amazon and is about 8 dollars a month.  (I have no relationship of any sort with this company – it is impossible to recommend a generic “probiotic”).  This particular product does contain the three strains used in this study.

Abstract

IMPORTANCE

Oral intake of new probiotic formulations may improve the course of atopic dermatitis (AD) in a young population.

OBJECTIVE

To determine whether a mixture of oral probiotics is safe and effective in the treatment of AD symptoms and to evaluate its influence on the use of topical steroids in a young population.

DESIGN, SETTING, AND PARTICIPANTS

A 12-week randomized, double-blind, placebo-controlled intervention trial, from March to June 2016, at the outpatient hospital Centro Dermatológico Estético de Alicante, Alicante, Spain. Observers were blinded to patient groupings. Participants were children aged 4 to 17 years with moderate atopic dermatitis. The groups were stratified and block randomized according to sex, age, and age of onset. Patients were ineligible if they had used systemic immunosuppressive drugs in the previous 3 months or antibiotics in the previous 2 weeks or had a concomitant diagnosis of intestinal bowel disease or signs of bacterial infection.

INTERVENTIONS

Twelve weeks with a daily capsule containing freeze-dried powder with 109 total colony-forming units of the probiotic strains Bifidobacterium lactis CECT 8145, B longum CECT 7347, and Lactobacillus casei CECT 9104 and maltodextrin as a carrier, or placebo (maltodextrin-only capsules).

MAIN OUTCOMES AND MEASURES

SCORAD index score and days of topical steroid use were analyzed.

RESULTS

Fifty children (26 [50%] female; mean [SD] age, 9.2 [3.7] years) participated. After 12 weeks of follow-up, the mean reduction in the SCORAD index in the probiotic group was 19.2 points greater than in the control group (mean difference, -19.2; 95% CI, -15.0 to -23.4). In relative terms, we observed a change of -83% (95% CI, -95% to -70%) in the probiotic group and -24% (95% CI, -36% to -11%) in the placebo group (P < .001). We found a significant reduction in the use of topical steroids to treat flares in the probiotic arm (161 of 2084 patient-days [7.7%]) compared with the control arm (220 of 2032 patient-days [10.8%]; odds ratio, 0.63; 95% CI, 0.51 to 0.78).

CONCLUSIONS AND RELEVANCE

The mixture of probiotics was effective in reducing SCORAD index and reducing the use of topical steroids in patients with moderate AD.

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Journal Abstract