Eczema is a term, used as broad heading; under it a group of medical conditions describe those causes dry, discolored, itchy and inflamed skin. Atopic Dermatitis is one of the seven common types of Eczema. Globally 5-30% of pediatric and 1-10% of adult population have Atopic Dermatitis. Atopic Dermatitis is inflammatory type of skin disease which is common in both pediatric and adults. In Atopic Dermatitis patient there is disruption of skin barrier and loss of moisture holding property of skin. Recent studies suggest that disturbance in skin and intestinal microbiota is majorly linked to skin diseases. Probiotics are known for the positive alteration of an individual’s microbiome and associated with several health benefits. Clinical studies suggest that probiotic and synbiotic supplementation protect infants from a stringent AD to some extent.
Probiotics are “Live microorganisms, which, when consumed in adequate amounts, confer a health benefit on the host.”
This is the modern definition of probiotics, drafted by joint expert consultation of the Food and Agricultural Organization and the World Health Organization in Argentina (2001).
Concept of Probiotic
Let’s first know about Microbiome…
Collection of all the microorganisms, living in association with the human body is known as human Microbiome. Microbiome is generally not harmful to human; in fact they are essential for maintaining health.
How Microbiome helps?
- They produce some vitamins that humans do not have the genes to make.
- Microbiome breaks down food to nutrients that human need to survive.
- Teach human immune systems to recognize foreign invaders.
- Microbiome also has some anti-inflammatory functions to eliminate other disease causing microbes.
In some disease condition, this microbiome gets affected. Replacing affected microbiome or adding microbes to microbioms can alter disease conditions. From this point concept of using probiotics for prevention & treatment came. When human body lose parts of Microbiome, like after taking antibiotics, after diarrhea etc probiotics can be used to replace them. Probiotics can be used to balance Microbiome and “bad” bacteria to keep body working the way it should.
Pro, Pre & Synbiotics
Let’s start with definitions:
Probiotics are live microorganisms, which, when consumed in adequate amounts, confer a health benefit on the host.
Prebiotics are metabolic fuel that microorganisms in the gastrointestinal tract use for their survival.
When Probiotic organisms and prebiotics are served as composition it’s often called synbiotics.
By definition Pro, Pre & Synbiotics are not same. That’s why; Probiotics should not be confused with prebiotics or Synbiotics.
There is disagreement about whether dead or deactivated microorganisms or microbial products should be included in the term “Probiotics”.
Commonly Used probiotic Strains:
Health benefits have mainly been demonstrated for specific probiotic strains of the following genera: Lactobacillus, Bifidobacterium, Saccharomyces boulardii, Enterococcus durans, Enterococcus faecium, Streptococcus thermophilus, Lactococcus lactis, Bacillus subtilis, Escherichia coli Nissle 1917 etc.
How Probiotic works?
In Gastrointestinal tract Probiotics reduce growth of pathogenic microorganisms,
- By fostering colonization resistance,
- By improving intestinal transit,
- By helping normalize a perturbed microbiota.
Probiotics helps in
- Production of bioactive metabolites (e.g., short-chain fatty acids)
- Reduction of luminal pH in the colon
Probiotics also helps in
- Vitamin synthesis,
- Gut barrier reinforcement,
- Bile salt metabolism,
- Enzymatic activity, and
- Toxin neutralization.
Through all of these mechanisms, probiotics have wide range of impacts on human health and disease.
Natural or Commercial Probiotics
Probiotics are present in some foods naturally by their process of food making. Foods those are preparing by the process of fermentation are usually rich in probiotics. The term probiotics comprises a number of microbes rather a single one. Healthy individuals can benefit from taking these foods regularly. But for a person who needs to be treated for a specific disease that need specific strain of probiotics in a calculated dose, commercial preparation of probiotics came in front.
Probiotics in Atopic Dermatitis Treatment
Several clinical studies were conducted to explore the therapeutic property of probiotic formulations against AD. Some of the studies showed positive results and others demonstrated no effect. A particular probiotic strain exhibits the protective act on AD in some group of the population that may not work on another study group. Multi-strain formulations and synbiotic preparations showed better protection from allergic diseases than single-strain or prebiotic interventions.
The clinical administration of probiotics may become more widespread if the remaining questions are answered with strong evidence: what type of probiotic strain should be used? What dosage and time of administration should be used? At what time of life is the use of probiotics more efficacious? And most importantly, should the use of probiotics be personalized?
However, most randomized controlled trials and meta-analyzes, support the administration of probiotics for at least 8 weeks with beneficial effects in improving severity scoring of atopic dermatitis.
It seems that high doses (3-50 billion CFu/d) of Lactobacillus rhamnosus, Bifidobacterium lactis and Lactobacillus acidophilus probiotics in single or multi-strain formulations currently hold the most promise for prevention and treatment of eczema, but more studies evaluating single and multiple strain probiotics and exact dosing are needed to confirm most beneficial bacterial species.
Atopic Dermatitis is the most common genetically transmitted skin disease which can affect individuals irrespective to age. Due to disease Burden and comorbid Conditions, Atopic Dermatitis have huge Economic & Social impact. Convincing number of physicians are prescribing probiotics treating Atopic Dermatitis now a days. But specificity and effectiveness of probiotics to treat Atopic Dermatitis is till now not proven strongly. You can find probiotics in online pharmacy in Bangladesh.
Dr Mohammad Shakiluzzaman (MBBS, FIPM)
- Sivamaruthi BS, Kesika P, Chaiyasut C. Probiotic based therapy for atopic dermatitis: Outcomes of clinical studies. Asian Pac J Trop Biomed [serial online] 2018 [cited 2020 Feb 6];8:328-32. Available from: http://www.apjtb.org/text.asp?2018/8/6/328/235328
- Eczema prevalence, quality of life and economic impact. National Eczema Association. https://nationaleczema.org/research/eczema-facts/. Accessed February 6, 2020.
- Rather IA, Bajpai VK, Kumar S, Lim J, Paek WK, Park Y-H. Probiotics and atopic dermatitis: an overview. Front Microbiol. 2016;7. doi:10.3389/fmicb.2016.00507
- Rusu E, Enache G, Cursaru R, et al. Prebiotics and probiotics in atopic dermatitis. Exp Ther Med. 2019;18(2):926-931. doi:10.3892/etm.2019.7678
- Probiotics and eczema | gut health and atopic dermatitis. National Eczema Association. https://nationaleczema.org/search-bacterial-balance/. Published August 13, 2013. Accessed February 6, 2020.
- Sivamaruthi BS, Kesika P, Chaiyasut C. Probiotic based therapy for atopic dermatitis: Outcomes of clinical studies. Asian Pacific Journal of Tropical Biomedicine. 2018;8(6):328. doi:10.4103/2221-1691.235328
Shakiluzzaman DM. Probiotics: things need to know. khidmat Drug Outlet. February 2020. https://www.khidmatdrug.online/probiotics-what-you-need-to-know/. Accessed February 6, 2020.