Probiotics and prebiotics for atopic dermatitis Original paper

This meta-analysis of randomized controlled trials found that adding probiotics and/or prebiotics to topical corticosteroid treatment reduced the severity of atopic dermatitis, compared with corticosteroids alone, but the certainty of evidence was low.

This Study Summary was published on February 5, 2024.

Quick Summary

This meta-analysis of randomized controlled trials found that adding probiotics and/or prebiotics to topical corticosteroid treatment reduced the severity of atopic dermatitis, compared with corticosteroids alone, but the certainty of evidence was low.

What was studied?

The efficacy and safety of adding prebiotics, probiotics, and synbiotics to topical corticosteroid (TCS) treatment for atopic dermatitis.

Who was studied?

A total of 1,230 infants, children, and adults diagnosed with atopic dermatitis. (This number represents all 21 studies that were initially included, but 1 unidentified study was later excluded from some or all of the analyses.)

How was it studied?

This meta-analysis included 20 randomized controlled trials (once the unidentified study was dropped) that compared TCS + prebiotics, probiotics, and synbiotics to TCS alone. Single strains of probiotics were used in 14 of the studies (most commonly Lactobacillus), while a combination of Lactobacillus and Bifidobacterium strains were used in 4 studies. The data on synbiotics (2 studies) and prebiotics alone (1 study) was limited.

The primary outcomes of interest were atopic dermatitis severity (assessed using the Scoring Atopic Dermatitis, or SCORAD, index) and the safety of TCS + prebiotics, probiotics, and synbiotics (based on the frequency of adverse events).

Secondary outcomes included pruritus (itching), quality of life, and the frequency of TCS usage.

Subgroup analyses were performed to assess the role of intervention type, atopic dermatitis severity, and participant age.

What were the results?

Adding prebiotics, probiotics, and synbiotics to TCS reduced (improved) SCORAD scores in comparison with TCS alone. However, heterogeneity was high, and the certainty of evidence was low. TCS + prebiotics, probiotics, and synbiotics led to a pooled reduction of 5.3 points on the SCORAD index; 8.7 points has been proposed as a minimal clinically relevant change in some research.[1]

The addition of prebiotics, probiotics, and synbiotics did not increase adverse event frequency in the primary analysis or in any subgroups.

No improvements in frequency of TCS usage, pruritus scores, or quality of life were observed with the addition of prebiotics, probiotics, and synbiotics.

The subgroup analysis found that Lactobacillus and Bifidobacterium combined with TCS reduced SCORAD scores, compared with TCS alone, and may be more effective than TCS +Lactobacillus only.

Analysis by participant age revealed that adding prebiotics, probiotics, and synbiotics reduced symptoms in children, but not in infants or adults.

The analysis by atopic dermatitis severity found that the participants with moderate or moderate-to-severe symptoms benefited from the addition of prebiotics, probiotics, and synbiotics, but the participants with mild or moderate severity did not.

This Study Summary was published on February 5, 2024.

References

  1. ^Schram ME, Spuls PI, Leeflang MM, Lindeboom R, Bos JD, Schmitt JEASI, (objective) SCORAD and POEM for atopic eczema: responsiveness and minimal clinically important difference.Allergy.(2012-Jan)