The Effectiveness And Safety Of Oral Microbial Agents As An Adjunct Therapy For Atopic Dermatitis: A Systematic Review
Keywords:
atopic dermatitis, eczema, microbial agents, pediatric eczema, probiotics, steroid-sparing effectAbstract
Background: Eczema, also known as atopic dermatitis (AD), is a chronic inflammatory skin condition that significantly impacts the quality of life for both children and adults, affecting up to 20% of children and 10% of adults globally. While topical corticosteroids (TCS) have been the primary treatment, their long-term use can lead to adverse side effects and corticophobia, underscoring the need for alternative therapies like microbial agents (MA) which have shown promise in improving eczema symptoms and reducing reliance on TCS. Methods: This systematic review focused on full-text English literature published between 2014 and 2024 using the PRISMA 2020 guidelines. The literature was compiled using PubMed, ScienceDirect, and SagePub, among other online venues. Result: Five publications were found to be directly related to our ongoing systematic examination after a rigorous three-level screening approach. Conclusion: This systematic review suggests that microbial agents (MA) are a promising add-on therapy for moderate to severe eczema in children when used alongside topical corticosteroids (TCS). Mixed-strain probiotics and synbiotics showed the most significant improvement in eczema severity, but the optimal dosage and steroid-sparing effect require further investigation. Future research should explore MA's effectiveness across different age groups and severities of eczema.
References
Davis DMR, Drucker AM, Alikhan A, et al. American Academy of Dermatology Guidelines: Awareness of Comorbidities Associated with Atopic Dermatitis in Adults. *J Am Acad Dermatol*. 2022;86(6):1335-1336.e18. https://doi.org/10.1016/j.jaad.2022.01.009
Schuler CF, Billi AC, Maverakis E, Tsoi LC, Gudjonsson JE. Novel Insights into Atopic Dermatitis. *J Allergy Clin Immunol*. 2023;151(5):1145-1154. https://doi.org/10.1016/j.jaci.2022.10.023
Laughter MR, Maymone MBC, Mashayekhi S, et al. The Global Burden of Atopic Dermatitis: Lessons from the Global Burden of Disease Study 1990-2017. *Br J Dermatol*. 2021;184(2):304-309. https://doi.org/10.1111/bjd.19580
Ismail N, Bray N. Atopic Dermatitis: Economic Burden and Strategies for High-Quality Care. *Br J Dermatol*. 2020;182(5):1087-1088. https://doi.org/10.1111/bjd.18636
Wollenberg A, Barbarot S, Bieber T, et al. Consensus-Based European Guidelines for Treatment of Atopic Eczema (Atopic Dermatitis) in Adults and Children: Part I. *J Eur Acad Dermatol Venereol*. 2018;32(5):657-682. https://doi.org/10.1111/jdv.14891
Wollenberg A, Christen-Zäch S, Taieb A, et al. ETFAD/EADV Eczema Task Force 2020 Position Paper on Diagnosis and Treatment of Atopic Dermatitis in Adults and Children. *J Eur Acad Dermatol Venereol*. 2020;34(12):2717-2744. https://doi.org/10.1111/jdv.16892
Lax SJ, Harvey J, Axon E, et al. Strategies for Using Topical Corticosteroids in Children and Adults with Eczema. *Cochrane Database Syst Rev*. 2022;3(3):Cd013356. https://doi.org/10.1002/14651858.CD013356.pub2
Barta K, Fonacier LS, Hart M, et al. Corticosteroid Exposure and Cumulative Effects in Patients with Eczema: Results from a Patient Survey. *Ann Allergy Asthma Immunol*. 2023;130(1):93-99.e10. https://doi.org/10.1016/j.anai.2022.09.031
Chiricozzi A, Comberiati P, D'Auria E, Zuccotti G, Peroni DG. Topical Corticosteroids for Pediatric Atopic Dermatitis: Thoughtful Tips for Practice. *Pharmacol Res*. 2020;158:104878. https://doi.org/10.1016/j.phrs.2020.104878
Zhang S, Wang R, Li D, Zhao L, Zhu L. Role of Gut Microbiota in Functional Constipation. *Gastroenterol Rep (Oxf)*. 2021;9(5):392-401. https://doi.org/10.1093/gastro/goab035
Notay M, Foolad N, Vaughn AR, Sivamani RK. Probiotics, Prebiotics, and Synbiotics for the Treatment and Prevention of Adult Dermatological Diseases. *Am J Clin Dermatol*. 2017;18(6):721-732. https://doi.org/10.1007/s40257-017-0300-2
Andrade PDSMAd, Maria e Silva J, Carregaro V, Sacramento LA, Roberti LR, Aragon DC, Carmona F and Roxo-Junior P (2022) Efficacy of Probiotics in Children and Adolescents With Atopic Dermatitis: A Randomized, Double-Blind, Placebo-Controlled Study. Front. Nutr. 8:833666. doi: 10.3389/fnut.2021.833666
Prakoeswa CRS, Herwanto N, Prameswari R, et al. Lactobacillus plantarum IS‐10506 supplementation reduced SCORAD in children with atopic dermatitis. Benef Microbes. 2017;8(5):833‐840. https:// doi.org/10.3920/BM2017.0011
Mitra Aldaghi, Human Tehrani, Maryam Karrabi, Fatemeh Sham Abadi & Mohammad Sahebkar (2020): The effect of multistrain synbiotic and vitamin D3 supplements on the severity of atopic dermatitis among infants under 1 year of age; a double-blind, randomized clinical trial study, Journal of Dermatological Treatment, DOI: 10.1080/09546634.2020.1782319
Yan DC, Hung CH, Sy LB, et al. A randomized, double‐blind, placebocontrolled trial assessing the oral administration of a heat‐treated lactobacillus paracasei supplement in infants with atopic dermatitis receiving topical corticosteroid therapy. Skin Pharmacol Physiology. 2019;32(4):201‐211. https://doi.org/10.1159/000499436
Dah-Chin Yan, Chih-Hsing Hung, Leticia B. Sy, Ko-Huang Lue, I-Hsin Shih, Chin-Yi Yang, Li-Chen Chen, Hai-Lun Sun, Min-Sheng Lee, Julie Chambard, Jérôme Tanguy, Betsy Hughes-Formella, Sophie Nutten, Carine Blanchard; A Randomized, Double-Blind, Placebo-Controlled Trial Assessing the Oral Administration of a Heat-Treated Lactobacillus paracasei Supplement in Infants with Atopic Dermatitis Receiving Topical Corticosteroid Therapy. Skin Pharmacol Physiol 3 July 2019; 32 (4): 201–211. https://doi.org/10.1159/000499436
Xue P, Qin H, Qin D, et al. The efficacy and safety of oral microecological agents as add‐on therapy for atopic dermatitis: a systematic review and metaanalysis of randomized clinical trials. Clin Transl Allergy. 2023; e12318. https://doi.org/10.1002/clt2.12318
Rosenfeldt V, Benfeldt E, Nielsen SD, et al. Effect of probiotic Lactobacillus strains in children with atopic dermatitis. J Allergy Clin Immunol. 2003;111(2):389‐395. https://doi.org/10.1067/mai.2003. 389
Ostojic M, Winkler PW, Karlsson J, Becker R, Prill R. Minimal Clinically Important Difference: don't just look at the "p‐value. Knee Surg Sports Traumatol Arthrosc. 2023;31(10):4077‐4079. https://doi.org/ 10.1007/s00167‐023‐07512‐x 49.
Schram ME, Spuls PI, Leeflang MM, Lindeboom R, Bos JD, Schmitt J. EASI, (objective) SCORAD and POEM for atopic eczema: responsiveness and minimal clinically important difference. Allergy. Jan. 2012;67(1):99‐106. https://doi.org/10.1111/j.1398‐9995.2011. 02719.x
Kim WK, Jang YJ, Han DH, et al. Lactobacillus paracasei KBL382 administration attenuates atopic dermatitis by modulating immune response and gut microbiota. Gut Microbes. 2020;12(1):1‐14. https:// doi.org/10.1080/19490976.2020.1819156
Uwaezuoke SN, Ayuk AC, Eze JN, Odimegwu CL, Ndiokwelu CO, Eze IC. Postnatal probiotic supplementation can prevent and optimize treatment of childhood asthma and atopic disorders: a systematic review of randomized controlled trials. Front Pediatr. 2022;10:956141. https://doi.org/10.3389/fped.2022.956141
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Sylvia, Daniel (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors publishing here keep copyright but grant the journal first publication rights, under a Creative Commons Attribution-NonCommercial 4.0 License. They can distribute their work non-exclusively elsewhere with an acknowledgment of its first publication in this journal. Posting the work online before and during submission for earlier and greater citation is encouraged, reflecting Open Access benefits.
