Probiotics mix may curb atopic dermatitis severity, topical steroid use in young people

By Marilynn Larkin

NEW YORK (Reuters Health) – An oral probiotic formulation may reduce both atopic dermatitis severity and use of topical steroids to treat it in young people with moderate disease, researchers say.

“The microbiota is essential for proper body growth, and the development of immunity and nutrition,” according to Dr. Vincente Navarro-Lopez of the Saint Anthony Catholic University San Antonia in Murcia, Spain. “Alterations in the microbiota could explain, at least in part, some epidemics of humanity such as obesity and atopic dermatitis.”

“(My) group has conducted several studies correlating the alteration of the microbiota with different neurological, infectious and skin diseases,” he told Reuters Health by email. “Some of these diseases show a specific dysbiosis in the intestinal microbiome.”

“We hypothesized that . . . by modifying the microbiome, we (will) manage to improve the disease,” he explained.

Building on their earlier unpublished microbiota studies in patients with moderate atopic dermatitis, Dr. Navarro-Lopez and colleagues conducted a 12-week, randomized, placebo-controlled trial. They enrolled 50 children (half female) ages four to 17 with a moderate SCORAD index (a measure of atopic dermatitis severity) at an outpatient clinic in Alicante, Spain.

The intervention group received a daily capsule of freeze-dried powder with 109 total colony-forming units of the probiotic strains Bifidobacterium lactis CECT 8145, B longum CECT 7347, and Lactobacillus casei CECT 9104 with maltodextrin as a carrier. The placebo group received maltodextrin-only capsules.

As reported in JAMA Dermatology, online November 8, the mean reduction in the SCORAD index in the probiotic group was a statistically significant 19.2 points greater than in the control group by the end of the 12-week treatment.

“In relative terms, we observed a change of -83% in the probiotic group and -24% in the placebo group,” the authors state. They also found a significant reduction in the use of topical steroids to treat flares in the probiotic arm (161 of 2,084 patient-days, or 7.7%) compared with the control arm (220 of 2,032 patient-days, or 10.8%).

Dr. Navarro-Lopez said, “What is really striking is how, with the normalization of the intestinal flora, there is a spectacular improvement in the skin lesions and symptoms that the patients suffer, improving the results of the usual treatment - topical corticosteroids.”

Dr. Adnan Mir, a pediatric dermatologist at Children’s Health and assistant professor at UT Southwestern in Dallas, commented, “Atopic dermatitis is extremely common, and occurs as a result of many factors including genetics, environment, and dietary exposures, as well as numerous other inputs. Because of this, there is no single intervention that works for everyone, and we take a similarly multifaceted approach to treatment.”

“This is a well-designed study with potentially exciting results showing that probiotics can be an effective adjunctive therapy,” he told Reuters Health by email.

He noted, however, that “the study population was fairly homogeneous, meaning that more research will be required to determine if these results are generalizable to a more diverse population.”

“Additionally, the study was limited to children four years of age and older, whereas atopic dermatitis tends to start during infancy,” he observed. “Previous work has shown that probiotics are not as effective in infants.”

“The study did not address dosing, and so it is possible that different doses may yield different levels of improvement,” he added. “They gave the same dose to school-aged children and older teenagers, and so there will be some room for modification.”

Dr. Howard Pride, chairman of the dermatology department at Geisinger Health System in Danville, Pennsylvania, commented, “Given the side effects associated with some therapies for atopic dermatitis, a safe and inexpensive intervention such as this is very welcome.”

Nonetheless, he said in an email to Reuters Health, “Despite improvement in objective measures, it is disappointing that subjective symptoms improvement was about the same as placebo.”

“Practitioners will need some guidance as to specific products to suggest to our patients that will match the probiotic mix of organisms and the dose used in the study,” he noted.

“The study was only 12 weeks in length, and atopic dermatitis is a chronic disease,” he added. “It is unknown (whether) the positive results will hold up over time.”

The study was funded by biotech company Biopolis and Korott, which develops probiotic supplements and employs two of the authors.

SOURCE: https://bit.ly/2zCS4ym

JAMA Dermatol 2017.