Practice Update
REVIEW · June 04, 2014
TAKE-HOME MESSAGE
- A review of studies testing probiotics and prebiotics used in dermatologic conditions reported a decrease in the incidence of atopic dermatitis (AD) in infants and some benefit in acne, photoprotection, and wound healing.
- Probiotics and prebiotics have antimicrobial properties that appear to play a role in T-cell inflammatory reactions. The best evidence for the use of probiotics is in infants to reduce the incidence of atopic dermatitis.
– Sarah Churton, MD
Expert Comment
Eliot N Mostow MD, MPH
As a general dermatologist, I believe it is critically important to be aware of research related to products our patients may choose to use on their own. The arena of “probiotics/prebiotics” is clearly an example where there are potential benefits, while, at the same time, a high potential for anecdotal and placebo effects for our patients. This nicely organized article reviews data on atopic dermatitis, acne, and wound care and reminds me to pay more attention to these products when I go to the store next time, but also to ask more of my patients about the products they use orally or topically.
With my special interest in wound care, I was especially interested in a small study from 2010 looking at venous leg ulcers treated with a topical probiotic, but the data on atopic dermatitis and even acne are better characterized at this point.
Katherine L. Baquerizo Nole MD
This study presents the following findings:
- Combined oral prenatal and postnatal use of certain strains of Lactobacillus and Bifidobacterium reduced the incidence of pediatric atopic dermatitis (AD) by 20% to 24%, especially during the first 2 years of life. However, its benefit in the management of AD is less clear.
- Data from small trials suggest the benefit of Lactobacillus (L. acidophilus, L. bulgaricus) and Streptococcus (S. thermophilus) in the management of acne vulgaris. Additionally, the use of probiotics may reduce the occurrence of Clostridium difficile–associated diarrhea in patients receiving chronic antibiotic therapy.
- Topical L. plantarum has been shown to decrease bacterial load in burns and wound area of chronic leg ulcers in small trials.
Although there are some data about the efficacy of probiotics in acne and wounds, the most robust evidence is in pediatric AD prevention. In this respect, most trials suggest that maternal supplementation of Lactobacillus (L. rhamnosus GG, L. acidophilus, and L. paracasei), and/or Bifidobacterium (B. bifidum, B. breve, B. longum, B. animalis, subsp lactis) strains is necessary for at least 2 to 4 weeks before and up to 3 to 6 months after delivery. Postnatal supplementation can be given either to the breastfeeding mother or directly to the infant.
Despite the abundance of commercially available probiotics, few match the probiotic mixture used in the clinical trials. Furthermore the strains of the available products may differ from the ones studied. Taking this into account, a search of the currently available probiotic formulations provided the following products as potentially useful because of the strain type, the dose stated in their ingredients, and the minimum products added: Nutramigen with Enflora LGG, 800 mL/daily as infant or toddler formula; Culturelle Health & Wellness Probiotics, 1 to 2 capsules daily; Genestra Brands HMF Forte, 1 capsule daily, or HMF Super Powder, 1 scoop daily; NutriCology BifidoLife, 1 capsule daily; KAL Acidophilus Probiotic-4, 3 capsules daily; and UAS Labs Probioplus DDS, 1 capsule daily.
Probiotic administration appears to be safe in pregnancy and in infants; however, every case needs to be assessed individually.
Topical preparations for acne and wound healing are not commercially available yet; however, oral BD Lactinex is on the market and it showed an 80% clinical improvement in acne patients in a 1961 study. Given the scarcity of data, more research is needed in these topics before a clinical recommendation can be made.
ABSTRACT
The rapid increase in the medical use of probiotics and prebiotics in recent years has confirmed their excellent safety profile. As immune modulators, they have been used in inflammatory skin conditions, such as atopic dermatitis. We review the literature regarding the use of probiotics and prebiotics in dermatology. 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. Their role in acne, wound healing, and photoprotection is promising, but larger trials are needed before a final recommendation can be made.
Journal of the American Academy of Dermatology
Probiotics and Prebiotics in Dermatology
J Am Acad Dermatol 2014 Jun 04;[EPub Ahead of Print], KL Baquerizo Nole, E Yim, JE Keri