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Probiotics and prebiotics in atopic dermatitis: Pros and cons (Review)
Ionut Serban Fanfaret1, Daniel Boda2,3, Laura Mihaela Ion3
1Pediatrics Department, Béziers Hospital Center, 34500 Béziers, France.
Insights
Research on prebiotics and probiotics for atopic dermatitis (AD) shows conflicting results. While some studies suggest benefits for this chronic skin condition, others indicate no significant efficacy, highlighting the need for further investigation.
Area of Science:
- Dermatology
- Microbiology
- Immunology
Background:
- Atopic dermatitis (AD) is a chronic inflammatory skin disease with impaired barrier function, increasing allergy risk.
- The pathogenesis of AD, particularly in children, remains poorly understood, necessitating further research.
- Existing literature on prebiotics and probiotics for AD presents significant variability and conflicting data.
Purpose of the Study:
- To critically analyze and standardize data on the use of prebiotics and probiotics in managing atopic dermatitis.
- To evaluate the efficacy of different probiotic and prebiotic strains, dosages, and application methods in AD treatment.
- To reconcile conflicting findings regarding the prophylactic and therapeutic effects of prebiotics and probiotics in AD.
Main Methods:
- Systematic literature review and critical analysis of studies on prebiotics and probiotics in atopic dermatitis.
- Categorization of studies based on intervention (probiotics alone, prebiotics alone, or synbiotics).
- Assessment of study outcomes, including efficacy measured by the Severity Scoring of Atopic Dermatitis (SCORAD) index, compared to placebo groups.
Main Results:
- The most frequently studied probiotics for AD were strains of *Lactobacilli* and *Bifidobacteria*.
- Conflicting results were observed, with some studies demonstrating positive effects and others showing no efficacy of prebiotics, probiotics, or synbiotics.
- Efficacy appeared more pronounced in moderate to severe AD cases and in patients with co-existing allergic diseases, though interpretation is challenging due to natural disease fluctuation.
Conclusions:
- The current body of evidence on prebiotics and probiotics for atopic dermatitis is highly variable and often contradictory.
- Further standardized research is required to clarify the role and optimal application of prebiotics and probiotics in AD management.
- The potential benefits of these interventions may be strain-specific and dependent on disease severity and patient characteristics.
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.
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