Children with moderate AD given a mixture of three strains of probiotics for 12 weeks saw a 19 point greater reduction in Scoring Atopic Dermatitis (SCORAD) Index than those given placebo, reported the research team led by the Universidad Católica San Antonio de Murcia, Murcia, Spain.
The scientists also found that probiotics induced a 29% reduction in the proportion of patient-days when steroid use was required to manage flare-ups of the disease.
“The results of our study indicate a strong positive effect in reducing the SCORAD index and use of topical corticosteroids in the group treated with the probiotic mixture,” wrote first author Dr. Vicente Navarro-López.
The scientists used a mixture of three strains of probiotic, in the light of earlier research on AD which had found better efficacy of multiple, rather than single, strains. The three strains used (in equal proportions) were Bifidobacterium lactis CECT 8145, B. longum CECT 7347, and Lactobacillus casei CECT 9104.
The findings are significant as they suggest the possible future use of probiotics as an effective adjuvant therapy to steroids.
“This evidence supports the efficacy of administering this probiotic mixture to patients with moderate AD and suggests that it could be used more extensively in clinical practice,” suggested Navarro-López.
Lowering the frequency of steroid use might also benefit patients in reducing their well-established adverse side effects.
The study design was a double-blinded, randomised placebo-controlled trial (RCT), which included 50 children aged between 4-17 years old with moderate AD.
Patients were required to be currently consuming a high-quality Mediterranean diet to be included in the study.
During the 12-week trial, all patients received moisturiser, an oral antihistamine and the topical steroid methylprednisolone aceponate.
Scientists gave the intervention group a daily pill containing one billion (1x109) colony forming units (CFU) of the probiotic mixture (described previously) in a maltodextrin carrier. The placebo group received a pill containing solely maltodextrin.
The researchers measured SCORAD Index at baseline and at four-week intervals throughout the trial period. The numbers of days of topical steroid use was reported every two weeks.
Two of the components of the SCORAD Index, eczema spread and intensity, showed significant improvements in the probiotic group only. The third SCORAD Index component (subjective symptoms) showed improvements in both intervention and placebo groups. The scientists suggested that greater use of steroids in the placebo group might explain this finding.
The team also found small, but not statistically significant improvements, in levels of inflammatory molecules. However, they stressed that the study was too small to measure differences in these cytokines effectively.
The promising results merit further research into the efficacy of probiotics in adjuvant AD therapy, advocated the researchers.
In particular, “Questions should be answered about adequate dosage, the duration of probiotic administration, and at what age the use of probiotics would be most efficacious,” they concluded.
Source: JAMA Dermatology
Published online ahead of print. DOI: 10.1001/jamadermatol.2017.3647
Effect of Oral Administration of a Mixture of Probiotic Strains on SCORAD Index and Use of Topical Steroids in Young Patients With Moderate Atopic Dermatitis: A Randomized Clinical Trial
Authors: Vicente Navarro- López et al