Probiotics and prebiotics in atopic dermatitis: Pros and cons (Review)

Abstract

Atopic dermatitis (AD) represents a chronic inflammatory skin condition in which the skin barrier is impaired; thus, the permeability is increased. Hence, there is a greater risk of allergic sensitization, as well as a higher pH and lower protection against resident microbes. Since this condition is currently increasing among children, it requires further study, as little is known regarding the pathogenesis that makes the skin prone to chronic relapsing inflammation. Trying to standardize the data regarding the use of prebiotics and probiotics in AD, we encountered tremendous variability in the literature data. Literature abounds in conflicting data: studies regarding prophylactic and therapeutic applications, different types of strains and dosages, applications in young children up to 5 years of age and above, usage of probiotics alone, prebiotics alone or synbiotics combined. There are also conflicting data regarding the outcome of these studies; some confirming a positive effect of prebiotics, probiotics or synbiotics and some showing no efficacy at all. The articles were divided into those assessing probiotics or prebiotics alone and a combination of the two, with studies showing a positive effect and studies proving no efficacy at all. We tried to critically analyze those articles showing weak and strong points. In summary, the most studied probiotics were the strains of Lactobacilli and Bifidobacteria . The Severity Scoring of Atopic Dermatitis (SCORAD) index was used to measure the efficacy of the treatment. Most studies compared their results with a placebo group and the efficacy when seen in moderate to severe forms of AD in patients with other allergic diseases present. However, the results are difficult to interpret, as in many studies the authors suggest that the disease may have a tendency to improve in time in some groups of patients.

Modulation of the Gut Microbiota with Prebiotics and Antimicrobial Agents from Pleurotus ostreatus Mushroom

“…If a substance meets the criteria for being a prebiotic, the consequences for gut microbiota and human health are shown in Figure 8. Prebiotics should be resistant to the upper gastrointestinal tract, reaching the colon, fermentation by probiotics, and selective stimulation of the growth of the intestinal bacteria [124]. During the fermentation of probiotics, the pH value is decreased, which creates an environment that is disadvantageous for the growth of pathogens and has shown to be supportive for beneficial bacteria.…”

Host-Microbe Interaction on the Skin and Its Role in the Pathogenesis and Treatment of Atopic Dermatitis

“…These are anaerobic, Gram (+) bacteria, belonging to the normal microbial flora. To be consumed by humans, probiotic microorganisms must be non-toxic and non-pathogenic [63][64][65]. Probiotics affect mainly the immune system and gastrointestinal tract by sealing the intestinal epithelium and inhibiting the penetration of allergens into the bloodstream [66,67].…”

Study of the effect of probiotics on the therapeutic effect obtained in the reduction of allergic symptoms in patients diagnosed with atopic dermatitis

“…Probiotics, as living bacteria, can significantly contribute to the reduction of AD symptoms of various aetiologies. Several conducted studies, including meta-analyses, provide evidence supporting the use of probiotics as an effective method in supporting the treatment of allergic diseases [8]. Potential mechanisms explaining the health-promoting effects of probiotic bacteria may involve restoring the normal gut microbiome through the modulation of the intestinal immune system and displacing potential pathogens through competitive exclusion.…”