Oct. 10, 2008 -- New research shows that the use of probiotics to treat eczema in children is not effective and may carry a risk of bowel damage and infection.
Probiotics are naturally occurring microorganisms. In most cases they are bacteria and are similar to the friendly bacteria found in the gut or skin. Lactobacillus and bifidobacterium are common probiotics that are found in many foods such as yogurt, unpasteurized milk, fermented soy and yeast, and infant formula.
People with eczema have what is believed to be a disorder of cells of the immune system. Probiotics have been used as a treatment for eczema in children. But a Cochrane Collaboration review of 12 studies involving 781 children concluded that there is no evidence that probiotics in supplement form reduce the symptoms of eczema or change its severity.
Probiotics for Eczema
The 12 studies were conducted between 2003 and 2008. The children ranged in age from 1 month to 13 years, but most of them were under 18 months old and appeared to have an allergy to cow's milk. The probiotic strain used most commonly in the studies was Lactobacillusrhamnosus, either alone or in combination with other probiotic bacteria.
The trials did not note any negative reaction to probiotics, but when Cochrane researchers dragged a net through a wider pool of studies, they found 46 cases in which probiotics were implicated in infection, bowel tissue damage, and even death, says Robert Boyle, MD, the lead researcher in the review.
Boyle is an allergist who teaches medicine at Imperial College in London. The bowel damage and fatalities occurred in patients with severe pancreatitis, he says.
"A wider trawl of literature showed that although probiotics are recognized as a safe treatment in otherwise healthy people, in people who are severely unwell, there is a significant risk in using probiotics," he says.
Boyle says he also wouldn't recommend giving infants probiotics, even if the infant is healthy. And he would not advise anyone with eczema to use probiotics because, he says, there are more effective treatments.
Eczema Common Worldwide
Eczema is characterized by dry, red, and itchy patches on the skin. The chronic, non-contagious condition affects 5%-20% of the world's population but is especially common in children, more than half of whom will outgrow it.
The American Academy of Dermatology says eczema may be an abnormal response of the body's immune system to allergens like animal dander and dust mites. There is no cure, but moisturizers are generally recommended, along with topical corticosteroids. In some cases, doctors recommend an antihistamine to reduce itching.
Probiotic supplements seem to reduce diarrhea and bloating in kids who have been treated with antibiotics, and they are marketed as such, but in her experience, they don't have a noticeable effect on eczema, says Nanette Silverberg, MD, director of pediatric and adolescent dermatology at St. Luke's-Roosevelt Hospital Center in New York City.
"Probiotics conceptually were well received by parents because it's a natural extract and if prepared properly could be quite safe. I haven't found them effective. I haven't seen any dramatic improvements in eczema," she says.
But Silverberg says there aren't enough data to prove either way the efficacy of probiotics. The review focused on small studies that might not give conclusive evidence.
Andrea Cambio, MD, FAAD, a dermatologist in Cape Coral, Fla., says patients and parents often ask about probiotics because they favor a more natural remedy to eczema. Still, she also hasn't seen positive results from probiotic treatment and isn't convinced they are completely safe. But she isn't discounting them completely.
"What is exciting is that his area of research has such great potential for future investigation," Cambio says.