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Probiotics and prebiotics for atopic dermatitis

This meta-analysis looked at all the existing trials on the common type of eczema called "atopic dermatitis", to see if combining pro- and prebiotics helps reduce symptoms.

Study under review: Synbiotics for Prevention and Treatment of Atopic Dermatitis: A Meta-analysis of Randomized Clinical Trials

Introduction

Atopic dermatitis is a form of eczema that stems from a predisposition toward developing allergic hypersensitivity reactions (this is the “atopic” part, which literally means “strange” or “out of place”). Other atopic diseases often associated with atopic dermatitis are asthma and hay fever. Atopic dermatitis is characterized by chronic, relapsing patches of dry, cracked, and itchy skin brought about through both an allergic immune response against skin cells and an abnormality in skin structure and function (although the etiology isn’t fully understood, yet).

Atopic dermatitis is very common, affecting[1] 10-20% of children in the developed world and a lower but growing prevalence in developing nations. Although it may occur at any age, around 50% of affected individuals develop symptoms[2] during their first year of life, while nearly all affected individuals will experience symptoms before the age of five. Symptoms may continue into adulthood, although the majority of children experience spontaneous remission of the disease before adolescence. Some additional facts about atopic dermatitis are listed in Figure 1.

Figure 1: Some facts about atopic dermatitis

Reference: Weidinger et al. Lancet. 2016 Mar.

The cause of atopic dermatitis is not known, but evidence suggests that the disease results from a combination of genetic[3] (hereditary) and environmental factors. One environmental factor that has received increasing attention for its role in this disease is the microbiome. While an increasing amount of research has shown that atopic dermatitis is associated with dysbiosis of the skin microbiome[4], the role that the gut microbiome plays has been less investigated.

Considering that the gut and its microbial inhabitants play a central role[5] in programming the infant immune system, it should come as no surprise that any and all diseases of the immune system are beginning to be examined in the context of the microbiome. Several[6] studies[7] have[8] associated[9] atopic dermatitis with a dysfunctional gut microbiome, and meta-analyses on probiotic[10] and prebiotic[11] supplementation have shown favorable results for these interventions in managing and preventing atopic dermatitis.

Prebiotics feed probiotics, which raises an interesting possibility that supplementing both may be more beneficial than supplementing either alone. Several studies have already investigated the efficacy of synbiotic supplementation (combination of pre- and probiotics) for the prevention and treatment of atopic dermatitis in children. The current study was a meta-analysis that was designed to to review these studies and determine where the weight of the evidence falls.

Atopic dermatitis is an allergic disease affecting a dysfunctional skin barrier that most commonly affects infants and children. Emerging research has linked this disease to the gut microbiome in various ways, and research thus far has supported a protective role of probiotic and prebiotic supplementation. The current study sought to review the literature, investigating whether synbiotic supplementation was also effective for the prevention and treatment of atopic dermatitis in children.

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