Probiotics for Eczema: Can It Help With Improving Symptoms?

Eczema, also known as the "itch that rashes," is a skin condition that can lead to recurrent infections and poor quality of life if left untreated. Probiotics have been proposed as an effective treatment option for eczema patients. However, before you consider using it, let's look at numerous clinical trials underway and the science behind their use.

What is eczema?

Eczema, or atopic dermatitis, is the most common form of dermatitis. Although it is seen most commonly in children, it is also increasingly reported in adults. It is often known as the "itch that rashes" since the dry skin leads to a rash due to scratching the area.

The main trouble in people with eczema is the dysfunctional skin barrier. Since the skin barrier is responsible for maintaining optimal skin hydration, its dysfunction results in excessive moisture loss and dry and dehydrated skin. Therefore, while moisturizing the skin seems logical, research shows that replenishing the skin barrier and gut health with probiotics may be beneficial.

What kind of probiotics can be used?

The main probiotic strains that have been ranked according to their efficacy for reducing the severity of eczema include:

• Mix1 (Bifidobacterium animalis subsp lactis CECT 8145, Bifidobacterium longum CECT 7347, and Lactobacillus casei CECT 9104)
• Lactobacillus casei DN-114001
• Mix6 (Bifidobacterium bifidum, Lactobacillus acidophilus, Lactobacillus casei, and Lactobacillus salivarius)

A systematic review found that compared with the placebo, the strains belonging to the group Mix1 reduced the symptoms of atopic dermatitis with certainty. In contrast, the strains belonging to Mix6 reduced the symptoms of atopic dermatitis to a lesser extent. Regarding safety, the highest-ranked strain is Lactobacillus fermentum VRI-003, while the lowest is Lactobacillus rhamnosus GG.

While their names might seem like mumbo-jumbo to new readers, scientists have been trying various strains of various species to study their effect on colonization of the gut and their influence in reducing the severity of eczema. Hence, it is worthwhile to check for these species when you get your next bottle of probiotics, especially if the intention is to improve eczema.

Can probiotics help with eczema?

Multiple individual studies claim the beneficial effects of reducing the symptoms and severity of eczema. However, the Cochrane Database studied 39 randomized controlled trials involving 2599 randomized participants. The researchers concluded that compared to the groups taking no probiotics, the currently available probiotic strains make little or no difference in improving symptoms related to eczema. Some of the hallmark findings of this report include:

• No difference in symptoms. Researchers found little or no difference in the symptoms of eczema between the groups that received probiotics and those that did not.
• No quality of life improvements. There was no evidence suggesting that probiotics make a difference in the quality of life for patients with eczema.
• Some improvement in severity. They found that probiotics could slightly reduce the Severity Scoring of Atopic Dermatitis (SCORAD) — an investigator's tool to assess the severity of eczema.
• No increased side effects. There was no evidence of an increase in side effects associated with the use of probiotics in those participants.

It is worthwhile to remember that while these findings were related to the use of probiotics in developed cases of eczema/atopic dermatitis, none of the studies that used probiotics to prevent eczema were included in the analysis. The beneficial effects of probiotics for gut health are well known, and considering probiotics as a potential to prevent eczema is worth investigating.

Topical probiotics for eczema

Several studies have shown that large colonies of Staphylococcus aureus are present on the dry skin of people with eczema. The disruption of the skin barrier, together with an increased population of S. aureus, can act as a trigger for eczema flares.

Several recent studies indicate that topical probiotics and emollients may be an excellent addition to treating eczema. Probiotics are known to block the release of specific inflammatory markers in the skin, which can help reduce the inflammation associated with this condition.

A study suggested that an ointment formulation containing 5% Vitreoscilla filiformis extract could reduce the severity of symptoms associated with eczema. Another study showed the effectiveness of the bacterium Streptococcus thermophilus by improving the ceramide concentrations in the outermost layer of the skin, thereby helping to improve and maintain the skin barrier.

The risks of topical probiotics for eczema

While there is potential for the beneficial use of probiotics to manage eczema, there is no regulation of proper labeling and marketing standards. Almost all probiotic-containing topical formulations have yet to go beyond the personal care product category, which means these products have the potential to be non-sterile and may contain antimicrobial preservatives, which may affect the viability of the probiotic strain in the first place.

At present, there are no specific guidelines for topical probiotic formulations. Hence, their use should be done only after a patch test and a healthcare professional's consultation.

The effective use of probiotics for eczema is still a topic that needs further conclusive evidence. Initial reports about the use of topical probiotics seem promising; however, there is no regulation or extensive randomized control studies to validate its use. While oral probiotics were not found to have a direct effect in improving eczema, their role in preventing eczema flares is still under investigation. Furthermore, there isn't strict regulation regarding the topical use of probiotics, which should be limited until we get better evidence to support its use.