Probiotics can improve patient-reported quality-of-life scores for children and adolescents with atopic dermatitis (AD) in the short term, a new meta-analysis suggested, but they did not improve clinical outcomes. Findings were reported in The Journal of Allergy and Clinical Immunology: Global.
Researchers, led by Muhammad Imran Arif, PhD, with the Department of Pediatrics, The First Affiliated Hospital of Xinjiang Medical University in Urumqi, China, assessed 13 randomized controlled trials that included 1133 children and adolescents that used the SCORing Atopic Dermatitis (SCORAD) scoring system to test efficacy. They compared effects of using probiotics with placebo in children and adolescents with AD.
They found a statistically nonsignificant difference in SCORAD within the first 2 months of the treatment (standardized mean difference [SMD], -0.04 [95% CI, -0.24 to 0.16]; P = .71; I2 = 52%), and found a statistically significant decrease in SCORAD with probiotics after 2 months (SMD, -0.20 [95% CI, -0.36 to -0.03]; P = .02; I2 = 77%).
Children using probiotics reported a reduction in symptoms such as itching and redness. “However, SCORAD varies considerably over time and paucity of long-term follow-up data makes it difficult to determine probiotics’ long-term clinical value,” the authors wrote.
Big Patient, Family Interest in Probiotics
Patient and family interest in use of probiotics is high as it is perceived as a more natural way to help manage AD in addition to the standard treatment of topical steroids, lotions, and medication injections. Difficulty in finding which treatments are effective stems from AD’s complexity, with genetic, immune, and environmental components, said An Huynh, MD, an allergist/clinical immunologist at Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire.
These authors have found that “potentially there may be some small benefit in using probiotics in pediatric and adolescent patients. But the benefit seems to be more related to how patients and caregivers perceive the eczema improving,” Huynh told Medscape Medical News. He noted that the authors report that there were no differences in how much topical steroids were used in the probiotics group. “So is there an actual change in clinical management of it? There doesn’t seem to be.”
Inconsistencies in Bacteria Studied
Huynh highlighted that the authors recognize that there is considerable variability in the way the trials in the meta-analysis were conducted. For instance, the trials have a lack of consistency both in which strains of bacteria are used and the levels of illness severity.
“The authors were able to find a marginal beneficial effect in combination with standard therapy,” for probiotics improving AD, said Maria I. Garcia Lloret, MD, with the Divisions of Pediatric Allergy and Immunology and Rheumatology at University of California Los Angeles Health. “But is this an earth-shaking paper? The answer is no.”
Messages for Patients
The authors emphasize that it’s important to counsel patients and caregivers that probiotic formulations vary greatly and it’s important to choose evidence-based products with demonstrated efficacy.
Garcia Lloret noted that probiotics are not a pharmaceutical product, are not regulated by the FDA, and they come in an array of forms over the counter. When patients ask which probiotic is best, she said, the science is not there to point to a superior source. “I tell them that, in general, they are safe. And in my opinion, they can’t hurt and they may be beneficial. We still haven’t nailed the exact combination of bacterium and the amount and when to start it.”
She said future studies should look at long-term effects and whether use of probiotics can reduce the constant use of topical steroids on children’s skin, which has been a big concern of parents.
This study was supported by the Open Project Fund of the State Key Laboratory of Pathogenesis, Prevention, and Treatment of Central Asian High Incidence Diseases and the Tianshan Talent High-Level Medical and Health Personnel Training Program of the Health Commission of Xinjiang Uygur Autonomous Region. The study authors, Huynh, and Garcia Lloret declared no relevant financial relationships.
Marcia Frellick is a Chicago-based independent journalist and a regular contributor to Medscape Medical News.
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