Atopic dermatitis is a chronic skin condition, which in most cases tends to appear at a very young age (in babies or young children), and which usually resolves or disappears over the years, as the person grows. It is common for it to occur with outbreaks, so that for a while symptom of any kind may not appear, and then later appear quite intensely.
In other words, it consists of a chronic condition that can appear and disappear throughout life, especially during the first years. To later disappear, resolve, or even overlap with other types of dermatitis.
In fact, atopic dermatitis is considered one of the most common types of dermatitis, which is usually known under the name “atopic eczema”. In the United States alone, it is estimated to affect more than 9 million children and about 16 million adults.
At the moment the exact cause is not known that causes, in people with atopic dermatitis, their immune system to become hyperactive, which triggers an inflammation that damages the skin barrier, leaving it not only dry or very dry, but also tends to be very prone to both itching and skin rashes, from then on most of the typical and characteristic symptoms of this disease appear.
It is known that genetics can influence a lot. In fact, research has found that some people with dermatitis, especially atopic dermatitis, have a mutation in the gene responsible for creating filaggrin, a protein that helps the body maintain a healthy, protective skin barrier on the top layer of skin, protecting it from environmental contaminants, dirt and microorganisms.
However, without enough filaggrin to build a strong protective skin barrier, bacteria, viruses, and other microorganisms can get in, and moisture can get out too easily. For all these reasons, it is common for most people with atopic dermatitis to have dry and itchy skin, and are also prone to infections. In other words, the skin tends to be more vulnerable to external aggressions, which is why it favors the appearance of areas with dermatitis or eczema, which present as dry, inflamed, red, scaly and itchy areas of the skin.
In other words: there are certain areas where it is easier for external aggressions to enter, so it is common for different particles that end up affecting our immune system to gain access more easily. In fact, in people with atopic dermatitis, it is easy for allergens to contact the immune system through the skin, causing repeated sensitization, which over time can lead to the onset of allergy.
It usually begins in infancy, usually in the first six months of a baby’s life. And although it is a tremendously common and habitual form of dermatitis (which means that many people are affected by it), it is actually a type of eczema considered to be long-lasting -chronic- and serious. In fact, although it can improve over time, other times it can get worse, so that in some children the symptoms may decrease as they get older, while in others they will present and suffer flare-ups of atopic dermatitis until adulthood.
Sometimes what is known as atopic march can occur, in which atopic dermatitis arises with other allergic diseases, which is why it is also known medically as allergic march. Not surprisingly, it consists of the sequence in which allergic diseases occur. And, basically, it refers to the progression, in most cases predetermined, of the natural history of this type of disease, which tends to manifest progressively over several years.
This means that the first stage arises with atopic dermatitis. Subsequently, food allergies may appear (something that usually occurs between 6 and 12 months of age of the child), childhood asthma and allergic rhinitis (on this occasion, rhinitis is more common during puberty, adolescence or even in adulthood). It is precisely this repeated sensitization that eventually leads to the appearance of an allergy, and a little later, food intolerances, rhinitis and asthma.
In any case, it is clear that the symptoms of atopic dermatitis are quite characteristic. In fact, itchiness becomes one of the hallmark symptoms of eczema. Not in vain, some statistics indicate that around 85 percent of people with this condition experience it daily. In addition, both pain and sleep disorders associated with this uncomfortable symptom are equally common.
It is common for affected people to have skin rashes on any part of the body, which can end up oozing fluid and bleed when scratched. And there is what is known as the itch-scratch cycle, so that itching causes the constant need to scratch, and that scratching causes more inflammation; in turn, that inflammation causes more of an urge to scratch. And again, the cycle repeats itself.
We must bear in mind that atopic dermatitis can end up profoundly disturbing the quality of life of the affected person, in addition to the development of other diseases or associated conditions, such as food allergies, asthma and allergic rhinitis. In addition, it is common for children, especially when they are still young, to not cooperate too much when applying the treatment, so their quality of life decreases as a result of the different uncomfortable and bothersome symptoms that commonly accompany dermatitis. atopic (itching, in fact, becomes one of the most problematic). Hence, the application of the treatment is essential, and above all, as soon as possible.
What are probiotics?
Probiotics consist of a number of live microorganisms that, when ingested, provide numerous health benefits and properties. They are usually bacteria, although it is also true that different types of yeast can also act and function as probiotics. It is possible to obtain them from nutritional supplements, or also in foods prepared by bacterial fermentation.
The most common groups mainly include Bifidobacterium and Lactobacillus. Although it is true that each group, in turn, includes different types of species. And, in turn, each species has many strains. Among the most common probiotic foods we can mainly mention yogurt, kefir, tempeh, sauerkraut and kimchi. Also, they should not be confused with prebiotics, which differ in that they are useful dietary fibers to feed the beneficial bacteria that are already naturally found in the intestine.
In other words, probiotics consist of live microorganisms that, when administered in sufficient quantities, provide interesting benefits, since they block the epithelium and the different mucosal surfaces of the intestine, thereby preventing the invasion and adherence of pathogens.
After the moment of birth, the person receives a primary microbial stimulus through the installation of the intestinal microbiota, or through exposure to specific bacterial strains.
It is this establishment of the microbial flora in the early postnatal period that helps to activate the innate and adaptive immune systems, while continued microbial stimulation helps the gut mucosal immune system to mature. However, when the microbial stimulus is compromised it can lead to reduced or diminished intestinal surface area, altered and uncoordinated intermediate mucosal metabolism, a mucosal secretory IgA system, and a sensitive mucosal barrier. In this sense, an imbalance in the Th1/Th2 immune response has been related to the pathogenesis of allergic diseases.
The use of probiotics in the treatment of atopic dermatitis
We must bear in mind that a complex community of microorganisms lives in our intestine (to a greater extent in the large intestine or colon), which is known as the microbiota or intestinal flora. According to some estimates, there are believed to be hundreds of different types of microorganisms, up to 1,000. Which includes not only bacteria, but also viruses and yeasts. Although, it is true, bacteria are the majority.
And the intestinal flora, although it may surprise you, performs many functions that, in short, are essential when it comes to maintaining good health. For example, it is responsible for making some vitamins (especially some B vitamins and vitamin K), converts fibers into short-chain fats useful for feeding the intestinal wall and carrying out many metabolic functions, which in turn they stimulate the immune system and strengthen the intestinal wall. This can help prevent certain unwanted substances from entering the body and causing or triggering an immune response.
A large number of studies have explored the potential efficacy of probiotics not only in the prevention but also in the treatment of atopic dermatitis. And Lactobacillus rhamnosus has been the most studied probiotic strain. For example, prevention studies have been carried out in children at high risk of atopic dermatitis, and probiotic administration was given 2 to 4 weeks before birth to pregnant mothers, and subsequently after the baby was born for a 1-year period.
We can mention, for example, an epidemiological study, which investigated the possible association between the administration of probiotic milk both during pregnancy and in childhood, and the appearance or establishment of certain atopic diseases, such as could be the case of atopic dermatitis itself, asthma and rhinoconjunctivitis. He found an inverse correlation between the intake of probiotic dairy products and the incidence of atopic dermatitis.
Another study published in 2014 evaluated the impact of the administration of Bifidobacterium breve and Bifidobacterium longum during a period of time of 1 month before birth, 6 months during infancy and a follow-up period of 18 months in the management of diseases. allergic diseases. The researchers concluded that the incidence of atopic eczema was lower in those cases in which probiotics were administered, compared to controls.
And, according to experts, bacteria may play an important role in atopic dermatitis, as well as in the general health of the skin. In fact, beyond the frequent skin infections commonly associated with serious diseases, there is the belief that colonizing bacteria, those that reside on the skin, could also drive inflammation. For example, a study published in 2008 found that, in people with atopic dermatitis, the balance of bacteria on the skin was very abnormal, with an increase in “bad” bacteria, mainly staphylococci.
It turns out that our body harbors an incredible amount of bacteria. Thus, as a whole, the microorganisms that inhabit our body are known by the name of microbiona. And much of the research that’s going on right now is focused primarily on gathering the data on these microbial communities, and where they’re found in the largest numbers in the human body, and what the implications are. different changes in the microbiome influence human health.
The truth is that, despite the enormous activity carried out by researchers in relation to investigating and discovering whether probiotics can help treat diseases, the data that would support their efficacy have been mixed, while clinical evidence on the use of specific probiotic strains for the treatment or prevention of diseases is still limited.
For example, the studies with the most promising results have shown that they could be useful both in the prevention and in the treatment of gastrointestinal diseases, especially antibiotic-associated diarrhea, known as traveler’s diarrhea and irritable bowel syndrome. A study published in 2012 found that supplementation with probiotics from multiple strains of Lactobacillus and Bifidobacterium shows a decrease in the severity of symptoms associated with irritable bowel syndrome, while a systematic review published a few years earlier, in 2009, concluded that a single specific strain – of Bifidobacterium infantis – showed efficacy in improving IBS symptoms.
But what about the skin? And particularly with atopic dermatitis? We must bear in mind, as we have already mentioned, that atopic dermatitis is often associated with other allergic diseases, and many experts advocate what is known as the atopic march, which we have already seen is a theory that suggests that dermatitis can cause subsequent allergic conditions, mainly in the respiratory tract and in the gastrointestinal systems. Hence, there is a significant and evident interest in the prevention of atopic dermatitis in order to stop the development of other allergic diseases.
Since the bacterial flora has been found to be quite different in those with atopic dermatitis, the main idea of experts is to add back healthy bacteria as a convincing medical treatment. Already in 2001 a study found that the probiotic strain Lactobacillus rhamnosus GG was able to reduce the incidence of atopic dermatitis in babies at risk up to the age of 7 years.
In 2005, a scientific article showed that some probiotics administered twice a day in children with moderate to severe atopic dermatitis (the same that would influence the appearance of what is known as atopic march), achieved significant improvements, compared to those patients in which only a placebo was used. However, in 2008 a study did not find a reduction in the incidence or severity of symptoms of atopic dermatitis after supplementation with probiotics, finding an association between such supplementation, with a higher incidence of bronchitis with wheezing.
In subsequent studies, the researchers experimented with different strains of probiotics. Thus, in 2009, participants in a trial received a multi-strain probiotic supplement (particularly Lactococcus lactis, Bifidobacterium bifidum, and Bifidobacterium lactis), or a placebo administered prenatally, 6 to 8 weeks before delivery, and after of the baby’s birth, for 12 months. Faecal colonization with Bifidobacterium was confirmed in 100 percent of the cases in the probiotic group at three months of age, while only 85 percent of the control group showed such colonization. In addition, a higher proportion of the probiotic group also showed colonization byLactococcus lactis.
On the other hand, the blood tests used to measure the different levels of inflammatory markers revealed lower levels in the probiotic group, which would also suggest an anti-inflammatory effect.
But this is not all: a meta-analysis of 14 trials found that probiotics reduced the incidence of atopic dermatitis, regardless of when the supplementation was given (prenatal or postanal, ie pregnant mother or child). Similarly, a 2012 review found a significant reduction in the risk of atopic dermatitis in children 2 to 7 years of age following the administration of Lactobacilli strains of probiotics throughout pregnancy.
Another study published in the same year -2012- found that supplementation with Bifidobacterium longum and Lactobacillus rhamnosus strains or Bifidobacterium longum and Lactobacillus paracasei in combination was able to reduce the risk of developing atopic dermatitis in infants. A total of 241 mother-child pairs participated in this particular study; Breastfeeding mothers were supplemented with probiotics 2 months before delivery and during the first 2 months of breastfeeding. And the reduction in the development of atopic dermatitis was confirmed in those babies considered to be at high risk up to 2 years of age.
Treatment of atopic dermatitis with probiotics
Some researchers believe that atopic dermatitis begins in the intestine, which would mean that the different collective microorganisms that live in the digestive system (that is, in what is known as the intestinal microbiome) are unbalanced. In fact, some studies have shown that those with atopic dermatitis also have a less diverse gut microbiome, compared to those without this type of condition.
And scholars theorize about the possibility that the lack of bacteria naturally present in the intestine can decrease and reduce immunity, leaving people more predisposed to certain inflammatory diseases, such as atopic dermatitis.
We already know, as we have seen, that probiotics can be extremely useful in positively influencing the gut microbiome. But the reality is that a change in this microbiome does not always correlate with an improvement in atypical dermatitis, so more research is needed on this.
Regarding scientific research mainly focused on the use of probiotics for the treatment of already established atopic dermatitis, for the moment it has not yielded such promising results, compared to its benefits when it comes to preventing its appearance in children. risky. In fact, so far the research that has been commissioned to study the effects of probiotics in the treatment of dermatitis has yielded mixed results.
We can mention a meta-analysis that found that probiotics could be useful in the prevention and treatment of atopic dermatitis, which, as we have already seen, is considered the most common type of dermatitis or eczema. Looking at the findings of several previously published clinical trials on the use of probiotics and atopic dermatitis, the authors of the meta-analysis, published in the Annals of Allergy, Asthma and Immunology, found that probiotics appeared to be effective in preventing the condition. especially Lactobacillus sp.
However, the researchers are clear on this point: while it is true that probiotics would help reduce the severity of symptoms commonly associated with dermatitis (and particularly atopic dermatitis), many of these trials found that probiotics had not been successful. reduce inflammation, which is one of the main characteristics of atopic dermatitis.
For example, a review carried out in 2008 in which 12 trials were analyzed was not able to find differences in the results related to the use of probiotics and placebos. Even a small increased risk of certain adverse effects, such as intestinal ischemia or infections, was found in those who used probiotics. On the other hand, a 2010 review that analyzed the clinical evidence for the use of probiotics in the treatment of atopic dermatitis found no convincing evidence to recommend the use of probiotics for this purpose.
It has been found that high doses of certain probiotics, including Lactobacillus acidophilus, Lactobacillus rhamnosus and Bifidobacterium lactis in formulations of one or several strains, do seem to be the most promising not only in the prevention but also in the treatment of atopic eczema. Although, it is true, more studies are not yet needed in order to assess whether they can be useful for single or multiple atopic dermatitis. Moreover, the use of strain probiotics and the exact dosage is necessary to confirm which would truly be the most beneficial bacterial species in this regard.
For all these reasons, and despite the initial promises, the use of probiotics in the prevention and treatment of atopic dermatitis is still not entirely conclusive, although it is possible that, as more data are discovered, it may be feasible to find the most useful bacteria with which to heal the skin.
And what about topical probiotics? Are they useful in the treatment of atopic dermatitis?
Research has shown, as we have already mentioned at some point throughout this note, that the different colonies of bacteria that live naturally on the skin tend to be different in those people who have dermatitis or eczema, compared to with those who do not suffer from this condition. As with the gut, it is thought that the skin microbiome in people with dermatitis tends not to be as diverse, which could make the skin more vulnerable to the proliferation of certain bacteria, considered bacteria ” bad”, as for example could be the case of Staphylococcus.
In fact, staphylococcus has been linked to dermatitis flare-ups, since it can end up triggering an inflammatory response in the skin. In this way, those who have eczema or dermatitis tend to have much higher populations of this type of bacteria on the skin.
Due to this, the idea behind what is known as topical probiotic therapy is to build a much healthier and healthier skin microbiome, by introducing those strains of bacteria considered most suitable in the skin, helping to keep at bay harmful “bad” strains of bacteria.
In this sense, researchers have examined, in recent years, how topical probiotics could affect the skin. And while it is true that these studies are relatively new at the moment, it seems that the results obtained so far have been promising.
Rose monas mucosa appears to have gone on to become a useful probiotic strain in the topical treatment of dermatitis. And it is that we tend to find this bacterium in a completely natural way on healthy human skin. For example, a small study published in 2018 found that a lotion containing this type of strain was able to reduce the amount of “bad” bacteria on the skin, while even improving the severity of dermatitis in people that they used it.
And it is the same thing that has happened with other strains of Lactobacillus, which would also have had positive results. For example, a study published in 2017 found that a topical lotion containing Lactobacillus johnsonii helped improve clinical symptoms of eczema, while also reducing the volume of “bad” bacteria on the skin. However, scholars are clear in this regard: most of the drawbacks related to these studies are the sample sizes, which are mainly characterized by being small. This means that more research is needed to fully understand what impact topical probiotics might have on dermatitis.
At the moment, therefore, topical probiotics have not been approved as effective treatments for dermatitis. In fact, it is still not entirely clear whether they are truly and truly effective in improving eczema. What’s more, as we’ve seen, while some studies found that topical probiotics did show promising results, others found no improvement at all. Therefore, although it is true that topical probiotics can be very helpful in improving the severity of dermatitis, experts are clear in this regard: they should never be used as a replacement for conventional treatments that do seem to be effective for eczema, as well as regular hydration.
Do probiotics help prevent childhood atopic dermatitis?
We have already seen that atopic dermatitis is characterized by being quite common in babies and children, mainly due to the fact that their immune system is still developing, which is why they tend to be more vulnerable to this condition.
While it is true that the research to date on the use of probiotics as a treatment for childhood dermatitis is still somewhat limited, the studies available to date have produced contradictory results.
This is what happened with a review published in 2010, in which more than a dozen clinical trials were analyzed on the supposed effectiveness of the use of probiotics in the treatment of atopic dermatitis in children. They concluded that there is not enough evidence to support its use.
The same thing happened with another study, this time published in 2017, in which researchers examined what the effects of probiotics would be on dermatitis, rhinitis and asthma in babies considered to be at high risk. Newborns, for example, were given Lactobacillus rhamnosus GG for around 6 months. They found that preventive supplementation at a rather early stage was not helpful in preventing the development of asthma or dermatitis at 2 years of age.
But there is, as we have seen, some evidence that children whose mothers used probiotic supplements during pregnancy might have a reduced risk of dermatitis. This is what a review published in the British Journal of Nutrition found, in which the researchers analyzed different clinical trials previously published (specifically, a total of seven trials). They found that the use of certain probiotics during pregnancy was useful in preventing dermatitis in children 2 to 7 years of age.
Not surprisingly, the authors of this review pointed out that, while it is true that Lactobacilli bacteria seemed to be useful in protecting against dermatitis, supplements containing a combination of several strains with probiotic qualities did not influence the development itself of eczema.
Other treatment options for atopic dermatitis
When it comes to the different treatment options, many experts consider that treatment necessarily involves a partnership between the doctor and the affected person, and even the different members of the family. Depending on the patient’s age, symptoms, and general health, the doctor will suggest an appropriate treatment plan.
Active skin care is essential. The use of a non-aggressive neutral soap is essential, as well as a moisturizing cream. We must bear in mind that the use of different soaps, fragrances, lotions or even a mixture of products can cause the appearance of greater skin sensitivity, and with it many more problems. Therefore, healing the skin and keeping it healthy is of some importance, especially when it comes to preventing further damage, and thereby improving the patient’s quality of life.
To achieve this, it is extremely important to develop and follow a daily skin care routine, which will help prevent recurring episodes and breakouts. One of the key factors, especially in babies and young children, is the moment of bathing, with the subsequent application of an emollienton still damp skin. This is because it helps to retain the moisture still present in the skin, so that most of the symptoms associated with atopic dermatitis tend to improve. In other words, it restores moisture to the skin and inhibits the evaporation of water, thus increasing the speed of healing and establishing a healthier barrier, useful against dryness, itching and irritation. In addition, it is also essential to avoid hot baths and showers, since the high temperature can affect the skin a lot.
When it comes to the emollients to use, it is essential to avoid lotions that contain a high content of water or alcohol, since they tend to evaporate quickly. What’s more, alcohol can increase symptoms by causing more inflammation, redness, and worse, itchiness. Creams and ointments become the best options when it comes to healing the skin. And Vaseline is one of the most useful options.
How to choose a probiotic?
Although probiotics have not been shown to be 100% effective in preventing the development of atopic dermatitis, or relieving its most serious symptoms, they are useful by providing a number of known benefits and qualities. For example, they are beneficial when it comes to relieving and treating diarrhea caused by the use of antibiotics, irritable bowel syndrome and what is known as traveler’s diarrhea.
If you want to add probiotics there are different options when it comes to adding them, either through diet or in the daily skin care routine. Here are some useful ways and examples:
It becomes possibly one of the simplest, easiest and easiest ways to provide probiotics to our body: through the different foods we consume every day. For example, certain fermented foods stand out, among which miso, sauerkraut or kimchi stand out. And also other probiotics that we find in certain cultured dairy products, such as kefir and yogurt.
However, depending on the processing method, the amount of living organisms present in each food can vary greatly. On the other hand, although its consumption is considered safe, it is known that some people may experience mild side effects, such as abdominal swelling or gas.
Probiotic supplements also become another useful option, which can be easily found in herbalists and in specialized diet and dietary supplement stores.
As most experts agree, getting your probiotics from food is preferable to supplements, since food generally tends to contain a higher amount of probiotics per serving. In any case, it may happen that we simply do not like fermented or cultured foods. In these situations, supplements do become a good alternative.
They are the options used in the treatment of atopic dermatitis. In fact, probiotic-containing skin care beauty products are becoming more and more popular. And they can be easily found in beauty supply stores and even on the beauty and cosmetics shelves of many supermarkets and department stores.
We must bear in mind that a topical probiotic will not help treat eczema. In fact, these types of products are not, at least for the moment, considered truly useful topical treatments against dermatitis, and they have not been classified as medicines.
In any case, if you try one, it is essential to choose it in the same way as you would choose any product that you are going to use on the skin: it must not have a fragrance, be hypoallergenic (so that it does not increase the risk of irritating dermatitis even more), and do what is known as the patch test, which consists of applying a very small amount of product to an area of the skin that is not so visible, and waiting for at least 24 hours to check if allergic reactions have occurred or not.
If no reaction of any kind has arisen, it will be a sign that you can use it with absolute peace of mind.