Probiotics may reduce SCORAD, steroid requirement in children with atopic dermatitis
Daily doses of the probiotic strains Bifidobacterium lactis CECT 8145, Bifidobacterium longum CECT 7347, and Lactobacillus casei CECT 9104 may reduce the SCORAD* index and need for topical steroids in children with moderate atopic dermatitis, according to a small study from Spain.
“Our results suggest that administration of this mixture of probiotics, as adjuvant treatment, may be effective in reducing the SCORAD index and, subsequently, decreasing the use of steroids during [atopic dermatitis] flares,” said the researchers.
Fifty children aged 4–17 years (mean age 9.2 years, 50 percent female) presenting at the Centro Dermatológico Estético de Alicante in Alicante, Spain who had been prescribed topical steroids for atopic dermatitis (moderate SCORAD index, 20–40) were randomized to receive a capsule containing freeze-dried powder with 109 total colony-forming units of Bifidobacterium lactis CECT 8145, Bifidobacterium longum CECT 7347, and Lactobacillus casei CECT 9104 with maltodextrin carrier or a placebo capsule (maltodextrin only) daily for 12 weeks. Participants were on a Mediterranean diet (KIDMED** score >7) and were prescribed topical methylprednisolone aceponate, a moisturizer, and an oral antihistamine.
Patients with a history of systemic immunosuppressive drug use in the last 3 months or antibiotics in the last 2 weeks, those with signs of a bacterial infection, or those with intestinal bowel disease were excluded.
A higher proportion of participants on probiotics experienced improvements in SCORAD index during the trial period compared with placebo (96 percent vs 46 percent). Participants who received probiotics also demonstrated a greater mean reduction in the SCORAD index compared with those who received placebo after 12 weeks (mean difference in SCORAD score, -19.2, 95 percent confidence interval [CI], -23.4 to -15.0; mean difference in proportional effect, -59 percent; p<0.001 in favour of probiotic). [JAMA Dermatol 2018;154:37-43]
Participants on probiotics also reduced their usage of topical steroids to treat flares (disease worsening requiring topical steroid use for ≥3 consecutive days) compared with those on placebo (161 of 2,084 patient-days [7.7 percent] vs 220 of 2,032 patient-days [10.8 percent], odds ratio [OR], 0.63, 95 percent CI, 0.51–0.78; p<0.001). In an analysis which included topical steroid use during non-flares, participants on probiotics still had fewer days of steroid exposure compared with those on placebo (291 vs 336, OR, 0.77; p<0.003).
According to the researchers, the response on the SCORAD index was better in this study (83 percent relative reduction) compared with that in several previous studies (63–68 percent). [J Clin Gastroenterol 2012;46:S33-S40; Ann Dermatol 2012;24:189-193; Iran J Pediatr 2011;21:225-230]
Factors that may have influenced the effect of probiotics included a longer treatment period, a better response in patients >1 years of age or in those with moderate-to-severe disease, or a stronger effect with a probiotic mixture containing lactobacilli and bifidobacteria compared with a single probiotic, they said.
“[The] evidence [from this study] supports the efficacy of administering this probiotic mixture to patients with moderate [atopic dermatitis] and suggests that it could be used more extensively in clinical practice,” said the researchers.
However, they cautioned that the single-centre design limited the potential extension of these results to a broader population such as in infants younger than 1 year or in adults, as well as in patients living in other locations.
“[Q]uestions should be answered about adequate dosage, the duration of probiotic administration, and at what age the use of probiotics would be most efficacious,” they said, highlighting the scope for future research.