Effect of Oral Administration of a Mixture of Probiotic Strains on SCORAD Index and Use of Topical Steroids in Young Patients With Moderate Atopic Dermatitis

Abstract

IMPORTANCE Oral intake of new probiotic formulations may improve the course of atopic dermatitis (AD) in a young population.OBJECTIVE To determine whether a mixture of oral probiotics is safe and effective in the treatment of AD symptoms and to evaluate its influence on the use of topical steroids in a young population. DESIGN, SETTING, AND PARTICIPANTSA 12-week randomized, double-blind, placebo-controlled intervention trial, from March to June 2016, at the outpatient hospital Centro Dermatológico Estético de Alicante, Alicante, Spain. Observers were blinded to patient groupings. Participants were children aged 4 to 17 years with moderate atopic dermatitis. The groups were stratified and block randomized according to sex, age, and age of onset. Patients were ineligible if they had used systemic immunosuppressive drugs in the previous 3 months or antibiotics in the previous 2 weeks or had a concomitant diagnosis of intestinal bowel disease or signs of bacterial infection.INTERVENTIONS Twelve weeks with a daily capsule containing freeze-dried powder with 10 9 total colony-forming units of the probiotic strains Bifidobacterium lactis CECT 8145, B longum CECT 7347, and Lactobacillus casei CECT 9104 and maltodextrin as a carrier, or placebo (maltodextrin-only capsules).MAIN OUTCOMES AND MEASURES SCORAD index score and days of topical steroid use were analyzed.RESULTS Fifty children (26 [50%] female; mean [SD] age, 9.2 [3.7] years) participated. After 12 weeks of follow-up, the mean reduction in the SCORAD index in the probiotic group was 19.2 points greater than in the control group (mean difference, −19.2; 95% CI, −15.0 to −23.4). In relative terms, we observed a change of −83% (95% CI, −95% to −70%) in the probiotic group and −24% (95% CI, −36% to −11%) in the placebo group (P < .001). We found a significant reduction in the use of topical steroids to treat flares in the probiotic arm (161 of 2084 patient-days [7.7%]) compared with the control arm (220 of 2032 patient-days [10.8%]; odds ratio, 0.63; 95% CI, 0.51 to 0.78). CONCLUSIONS AND RELEVANCEThe mixture of probiotics was effective in reducing SCORAD index and reducing the use of topical steroids in patients with moderate AD. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02585986

A Randomized, Double-Blind, Placebo-Controlled Trial Assessing the Oral Administration of a Heat-Treated <b><i>Lactobacillus paracasei </i></b>Supplement in Infants with Atopic Dermatitis Receiving Topical Corticosteroid Therapy

“…These authors noted a significant improvement in SCORAD scores and quality of life indices following administration of the probiotics separately and in combination compared to placebo. In a setting with concomitant corticosteroid therapy similar to the present study, Navarro et al [18] presented strong evidence supportive of a reduction of the objective SCORAD and sparing of corticosteroid use following 12-week treatment of children aged 4–17 years suffering from moderate AD with a probiotic mixture of strains of Bifidobacterium lactis CECT 8145, Bifidobacterium longum CECT 7347, and Lactobacillus casei CECT9104. It is possible that the different results in similar study designs are primarily attributable to the choice of probiotic strains.…”

The Risk of Developing Constipation After Neonatal Necrotizing Enterocolitis

“…Although atopic dermatitis usually occurs between 3 and 6 months of age, the onset of symptoms may also start at or before 2 months, the period approximately when NEC occurs (16). Some studies have reported the use of oral supplementations with probiotics in the treatment of atopic dermatitis, and their findings seem to indirectly strengthen the association between gut dysbiosis and the development of atopic dermatitis (17,18). Our results showed no significant increase in the risk of developing atopic dermatitis, allergic rhinitis, and asthma in the NEC patients (median followup times of 29, 37, 43 months, respectively).…”

Changing our microbiome: probiotics in dermatology

“…Results from older meta‐analyses support the use of oral probiotics for the treatment of AD and even for prevention, suggesting that Lactobacillus alone and Lactobacillus with Bifidobacterium bifidum are protective against development of AD, with odds ratios of 0·7 and 0·62, respectively . Additionally, daily oral supplementation with a mixture of Bifidobacterium and Lactobacillus casei strains for 12 weeks in patients with moderate AD led to a 19·2‐point greater mean reduction in SCORAD compared with control patients . However, some effects may be strain or species specific, as probiotics with Lactobacillus rhamnosus and Lactobacillus paracasei have yielded mixed results …”

“…30 Additionally, daily oral supplementation with a mixture of Bifidobacterium and Lactobacillus casei strains for 12 weeks in patients with moderate AD led to a 19Á2point greater mean reduction in SCORAD compared with control patients. 31 However, some effects may be strain or species specific, as probiotics with Lactobacillus rhamnosus and Lactobacillus paracasei have yielded mixed results. [32][33][34][35][36] Thus far, few studies have utilized live bacteria in topical probiotics for treatment of AD.…”