Dragana Skokovic-Sunjic
Clinical Pharmacist & Author,
Clinical Guide to Probiotic Products
When atopic dermatitis causes our babies and children to suffer from itchy, dry, and inflamed skin, probiotics are providing a new option for scientifically demonstrated relief.
When we talk about the human microbiome, the first thing that comes to mind is usually the gut. But, while the microorganisms in our digestive tract are indeed essential to good health, they are far from the only microscopic friends in, or on, our body. Our skin itself is home to hundreds of species of symbiotic bacteria and fungi. Understanding our relationship with them is critical to dermatological health, including the relief of skin conditions like atopic dermatitis.
The skin microbiome, the gut microbiome, and the other microbiota throughout our bodies are not isolated from one another. No bacterial colony is an island, so to speak. Recent scientific investigation has made it quite clear that interventions at the level of the gut can profoundly influence microbiome behaviour throughout the body, opening up significant new support pathways involving oral probiotics.
“In recent years, it has been established that there is a relationship between the gut microbiome and skin health,” says Clinical Pharmacist Dragana Skokovic-Sunjic, author of the Clinical Guide to Probiotic Products published by the Alliance for Education on Probiotics. “New evidence is pointing to a gut-microbiome-skin relationship where bacteria are communicating via our immune responses to have effects on the skin. It’s believed that our gut microbiome can affect maturation of the immune system through this kind of a crosstalk.”
Expanding the treatment playbook for a common ailment
For atopic dermatitis, specifically, the possibility of a new relief option through oral probiotics is extremely welcoming. Atopic dermatitis, or eczema as it’s commonly known, is an extremely common and chronic inflammatory skin disease that can vary in intensity from inconvenient to overwhelming.
“Atopic dermatitis is not life-threatening, but it has a high impact on quality of life for those affected, especially kids,” says Skokovic-Sunjic. “There’s intense itching, inflammation of the skin, disrupted skin barrier and risk of infection, interrupted sleep, and, when we’re not talking about infants, embarrassment related to the skin’s appearance. And atopic dermatitis is very prevalent in kids. The statistics show that 20% of the infant population around the world will have childhood eczema or atopic dermatitis, and we see this prevalence increasing. We see it most often before five years of age, and it’s particularly frequent in very young infants.”
The standard eczema treatment, for decades, has been topical corticosteroids, with systemic treatment being reserved for only the most severe cases due to the risk of unwanted side effects. For children, and especially infants, there is limited data on the long-term effects of corticosteroid use so health care providers are cautious about administering them. As a result this leaves a void in treatment of juvenile atopic dermatitis leaving parents with few choices backed by scientific evidence. Fortunately, with the advent of new probiotic research, that gap is finally being bridged.
“A few single probiotic strains and combinations of strains have been explored and have shown benefits for atopic dermatitis,” says Skokovic-Sunjic. “One particular combination of three strains has shown improvement in kids 4 to 17 years of age when assessing symptoms with a specific index which includes objective and subjective measures. Across the board, there was significant improvement in symptoms with this combination of strains. This probiotic is taken by mouth, meaning that the bacteria first goes to the gut, modulates the gut response, and communicates with the immune system, which then promotes improvement in the skin condition.”
Hard science, over the counter
The specific study which Skokovic-Sunjic is referring to was published in 2018 in the American Medical Association’s peer-reviewed journal JAMA Dermatology; the first time a probiotic study has been included in the prestigious publication. It’s important to recognize that, though probiotics are an over-the-counter option for relief the supporting evidence is straight-forward clinical research, held to the highest scientific standards. “This study uses selection criteria, includes randomization, blinding, there is a group that receives placebo, sometimes there will be crossover,” says Skokovic-Sunjic. “All those fancy words describe the gold standard of clinical investigation: a double-blind, placebo-controlled, randomized clinical trial.”
With that gold standard comes another important benefit, peace of mind. Many Canadians are rightly concerned about the safety of over-the-counter health products, and the scientific rigor with which probiotics are being investigated should thoroughly allay that concern. “People are often concerned about the safety of giving live bacteria to small kids, but there have been numerous studies showing their safety for use in children, infants, and even premature babies,” says Skokovic-Sunjic. “The only issue is selecting the appropriate one that is for the condition you wish to improve.”
We need to think about probiotics as a new opportunity to support skin health. Asking which specific probiotic strains have scientific evidence, demonstrating effectiveness and providing relief will help in the battle against skin conditions such as atopic dermatitis. Just as you wouldn’t take an antacid to deal with an ear infection, there’s no point in taking a Lactobacillus strain for a condition where only Escherichia has been shown to be effective. For atopic dermatitis, as for any condition, it’s essential that you speak with your doctor or pharmacist about the hard evidence when deciding which probiotic to use, or whether to use a probiotic at all.
