Efficacy of a probiotic supplement in patients with atopic dermatitis: a randomized, double-blind, placebo-controlled clinical trial

Abstract

Background: Atopic dermatitis (AD) is a multifactorial long-standing inflammatory skin disease with a high incidence worldwide in both adults and children. According to the recognized correlation between skin and intestine-the so-called "gut-skin axis"-gut unbalances can affect skin by inducing systemic inflammation and triggering dermatological diseases such as AD. Objectives: To evaluate the efficacy of a food supplement containing selected strains of probiotics in ameliorating AD symptoms and skin conditions in adult volunteers. Materials & Methods: Eighty adult subjects showing mild-to-severe AD, skin dryness, desquamation, erythema and itching were enrolled in a randomized controlled trial to receive, for 56 days, a placebo or a mixture of lactobacilli (L. plantarum PBS067, L. reuteri PBS072 and L. rhamnosus LRH020). The latter was chosen according to the patients' production of post-biotic metabolites and B-group vitamins, anti-inflammatory and anti-oxidant capacity and anti-microbial activity. Clinical and instrumental dermatological evaluation was performed at T 0d , T 28d and T 56d , and then at T 84d (after a one-month wash-out). Inflammatory cytokine levels from skin tape stripping, sampled close to AD lesions at T 0d and T 56d , were also measured. Results: Subjects receiving the probiotic mixture showed an improvement in skin smoothness, skin moisturization, self-perception, and a decrease in SCORAD index as well as in the levels of inflammatory markers associated with AD at T 28d , with a positive trend up to T 56d which was maintained at T 84d . Conclusion: Administration of selected probiotic strains resulted in a fast and sustained improvement in AD-related symptoms and skin conditions.

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“…The probiotic strains showed significant in-vitro ability in the modulation of inflammatory status and antimicrobial activity against skin pathogens such as C. acnes, S. epidermidis (data not shown) and S. aureus [20]. Furthermore, the same probiotic formulation resulted effective in a randomized doubleblind placebo-controlled clinical trial on adult subjects showing mild to severe atopic dermatitis, ameliorating skin clinical parameters (smoothness, moisturization and SCORAD index) and decreasing levels of skin inflammatory markers [21].…”

“…Likewise, probiotics have been demonstrated to help reducing the inflammatory cytokines cascade by several mechanisms such as upregulation of Treg cells and modulation of Th1 and Th2 response, and represent a therapeutic option without potential adverse events typical of chronic antibiotic use. The strains used in the food supplement have previously shown to reduce not only skin inflammation markers but also those related to the systemic inflammation [21,23]. Furthermore, they have been reported to successfully colonize the GI tract, showing long term performance in the reduction of skin condition symptoms [21,24].…”

“…The strains used in the food supplement have previously shown to reduce not only skin inflammation markers but also those related to the systemic inflammation [21,23]. Furthermore, they have been reported to successfully colonize the GI tract, showing long term performance in the reduction of skin condition symptoms [21,24]. This is particularly interesting considering the cross talk between the gut and the skin, where probiotics are responsible both for the production of beneficial metabolites that can reach the skin and for their antimicrobial activity through the release of bacteriocins, as reported for the strain L. plantarum PBS067 [25].…”

Manipulating Microbiota to Treat Atopic Dermatitis: Functions and Therapies

“…Supplement of other Lactobacilli appeared effective in alleviating AD symptoms as well, including L. salivarius [320,321], L. fermentum [322,323], L. sakei [324], L. plantarum [325][326][327], and L. paracasei [323], although contradictory results exist for L. paracasei [328]. Combination treatment of different Lactobacilli also potently attenuate AD [323,329,330]. Bifidobacteria are also used in RCTs against AD, particularly B. lactis.…”

Probiotics: Protecting Our Health from the Gut

“…Finally, in humans, an improvement in clinical symptoms in children and adults with AD has been reported [ 158 , 159 , 160 , 161 ]. The ingestion of probiotics from Bifidobacterium and Lactobacillus species is associated with a reduction in AD severity and TEWL, as well as an improvement in skin hydration [ 158 , 159 , 160 , 161 ].…”