Probiotics and Allergic Skin (Eczema) - A Look at 15 Years of Research.
By Dr. Frank, MD, PhD, Medical Director at AD RescueWear.
Before I discuss probiotics and allergic skin/eczema, I think it is important to review the current understanding that modern science has on the importance of gut bacteria in our overall health. For over 100 years we’ve understood that many plants and insects exist in a state of “symbiosis” with bacteria. Many plants are dependent on bacteria associated with their roots to allow extraction of nutrients from dirt. Between 10 - 15% of insects are dependent on bacteria for digestion of nutrients (including termites). While agricultural science has appreciated this necessary relationship with bacteria for 70 years, modern medicine has only recently noted that humans have a symbiotic relationship with gut bacteria, and the role (quantity/quality/composition) this gut bacteria plays in our health.
As the time line goes, humans have only recently been able to selectively or non-selectively kill bacteria without causing direct harm to the body. This occurred with the invention of sulfa antibiotics and penicillin in the late 1930s and early 1940s, and marked a significant revolution in our ability to treat acute bacterial infections such as pneumonia, meningitis, and skin infections. The next 80 years led to a remarkable development of numerous different types of antibacterial medicines that have dramatically increased the lifespan of the average human being on the planet. While treating acute infections, this use of antibiotics have led to the evolution of more aggressive, resistant, and toxic bacteria.
Only very recently and slowly has the medical community come to an understanding that nonselective destruction of the symbiotic bacteria in our body may not be the best thing for us. While important for digestion, gut bacteria are necessary for production of certain vitamins - like Vitamin K, the leading cause of Vitamin K deficiency is due to depletion of proper gut bacteria. Current evidence suggests that changes in our symbiotic gut bacteria, or “microbiome”, can play an important role not only in digestive diseases such as irritable or inflammatory bowel disease, but in systemic diseases such as autoimmune conditions, obesity, and even allergic conditions like eczema.
Probiotics are “good bacteria” that are found in healthy guts. Supplemental probiotics have been around for decades, but their optimal use has not really been established. However many doctors, including myself, are hopeful that we can learn how to use them effectively to help people with chronic health conditions.
One of the conditions that is extremely close to my clinical practice, as well as my own personal experience, is allergic inflammation of the skin or atopic dermatitis (eczema). More specifically the question of how certain bacteria in the gut contributes to total body allergic inflammation, with an impact on the skin. We think that “bad bacteria” multiply rapidly, use up too many key nutrients, and release inflammatory toxins that activate the gut’s immune barrier – leading to increased total body inflammation which pokes through the skin. While “good bacteria” are slower growing, allowing for better extraction of nutrients from food, and don’t release signals that challenge the immune system.
This article (Zuccotti G, Meneghin F, Aceti A, Barone G, Callegari ML, Di Mauro A, Fantini MP, Gori D, Indrio F, Maggio L, Morelli L, Corvaglia L on behalf of the Italian Society of Neonatology. Probiotics for prevention of atopic diseases in infants: systematic review and meta-analysis. Allergy 2015; DOI: 10.1111/all.12700) synthesized over 40 different research studies in the past 15 years, which looked at the impact of good bacteria, or the addition of good bacteria in patients that are high-risk for having atopic dermatitis (eczema), or that already had atopic dermatitis (eczema). There was no single repeatedly used protocol and the way that they administered these probiotics deferred significantly between studies. The overall impression is that the re-addition of good bacteria to the human body has a positive impact on allergic disease of the skin, and was significant and reproducible in most studies.
The overall number needed to treat was 1 in 13, which may not seem like a significant number, if you only had a 7.5% of having skin improved with probiotics. However, if you look at the number of people that are currently “liking AD RescueWear” on Facebook (which is close to 10,000 at the date of this publication), this number needed to treat represents over 800 kids with atopic dermatitis (eczema) who could be helped with this treatment. That is an extremely significant number to me. What this relatively low number does mean unfortunately, is that we do not have the “perfect probiotic approach” completely figured out. I do expect more studies and research to come out in the next few years.
I have my own “recipe and procedure” that I recommend to some of my personal patients, but it is not very common for me to make these recommendations. I always provide a probiotic when giving a broad-spectrum antibiotic, to minimize damage to the gut microbiome of my patients. I expect a lot more research and a lot more discussion on probiotics and human health as the medical community accumulates more data and we become better at healing our patients by restoring their optimal gut ecosystem.
Dr. Frank J Lichtenberger MD, PhD
Board Certified: Internal Medicine, Allergy/Immunology
Medical Director, AD RescueWear