Can probiotics help eczema in babies and children? Alternative remedies #4

Eczema is one of those horrible conditions where there is no one treatment which works for everybody. Annoying as it is, you will probably have to try lots of different things – ruling out particular foods, washing powders, fabric types – before you find the best way to prevent or alleviate the symptoms of eczema.

That’s why it is helpful to know of all possible preventions, remedies and treatments in order to see what works (if anything) for your child. If, like many parents, you’re constantly researching possible treatments for eczema, you’ll probably be aware of certain ‘alternative’ remedies like Aloe Vera which do, thankfully, seem to work for some children.

Along the same lines, there has been much discussion about the potential benefit of probiotics in treating eczema, and herein lies the good news. Recent research has found that certain probiotics can be helpful in the treatment of eczema.

What are probiotics?

Probiotics are live bacteria and yeasts, often referred to as “good” bacteria that provide health benefits when consumed. They help restore the natural balance of the gut microbiome, which can be disrupted by illness, poor diet, or antibiotics. We typically think of probiotics as fermented foods, like yogurt and kefir, but probiotics are actually just the bacterial component of these foods.

Probiotics are also available as food supplements, typically in powder or capsule form. These supplements are single bacteria strains or combinations of strains specifically chosen for their perceived benefits. Probiotic supplements are typically designed to support digestion. While these probiotic blends are usually based on good scientific evidence, they are not medicines and should not be treated as such.

Probiotics can also be used topically, i.e. directly onto the skin, in order to rebalance the skin’s microbiome. Topical probiotic skincare products can also contain prebiotics (food for your skin’s bacteria) or probiotic lysates (fermented, inactive bacterial by products) as well as the live bacteria. These products are typically designed to treat skin inflammation and to support the skin barrier.

How can the body’s microbiome affect eczema?

The gut biome

Studies have found significant differences between the gut microbiome of babies and children with eczema compared to their healthy peers. Eczema kids not only have reduced overall diversity in their gut biome but also increased colonisation by bad bacteria and reduced levels of good bacteria¹. In healthy children, the by-products of the good bacteria prevent excessive inflammation, promote immune tolerance, protect against autoimmune responses and strengthen the gut barrier. In contrast the by-products of the bad bacteria promote inflammation². The imbalance of the gut biome in eczema sufferers is thought to result in high levels of inflammation and leakage of allergens from the gut into the bloodstream (read more about leaky gut here).

The skin biome

The skin biome describes the ecosystem of microorganisms that live on the skin’s surface. It works as a protective shield by competing with harmful pathogens, maintaining skin’s acidic barrier, and communicating with your immune system to control inflammation. Typically ‘good’ bacteria consumes dead skin cells and other waste products on the skin surface keeping it smooth and clean. The by-products of these good bacteria also maintain the skin’s acidity and contribute to its moisture content. As different microorganisms have different roles in the skin’s microbiome, a healthy microbiome needs to include a mix of species.

However, not all microorganisms colonising the skin are beneficial and eczema skin is particularly prone to over-growths of the bacteria Staphylococcus aureus. This bacteria thrives on the drier skin typical of eczema sufferers, often crowding out the good bacteria. In addition, the by-products of this bacteria can further aggravate the eczema and even make it resistant to topical steroid treatments³. S. aureus overgrowths have been correlated with eczema flare-ups⁴ and are commonly associated with difficult to treat eczema.

How can probiotics help eczema?

The aim of topical probiotic treatment is two-fold, to increase the levels of ‘good’ bacteria and their associated benefits and to crowd out the ‘bad’ bacteria. This can be done in two ways:

• Introducing more of the good guys: In the case of the gut, this could be by taking food supplements containing the good bacteria; or by eating more fermented foods like live yoghurt, kefir, sauerkraut, sourdough, aged cheese, vinegar. For the skin, this could also be by finding a cream with added good bacteria species.
• Making your biome more welcoming to the good guys but providing a good energy source. For your gut this means adapting your diet by eating plenty of fibre in the form of fruit and veg as well as wholegrains, nuts and legumes. Cutting back on processed sugars and carbohydrates will help to reduce the bad bacteria. For the skin, this means keeping the skin well moisturised and slightly acidic perhaps with a prebiotic emollient.

The aim is to rebalance the body’s biome in favour of the good bacteria. This should reduce inflammation and irritation and allow the skin to heal.

Is there evidence supporting the use of probiotics to treat eczema?

Studies into the effectiveness of probiotics in treating eczema are currently limited and most studies are too small to draw firm conclusions. However, there are some probiotic strains, both oral and topical, that appear to show encouraging results and this is an active area of research.

It’s important to understand that different species of bacteria have a different effect on the body. In order to be effective, you need to match the species to the problem.

• Bifidobacterium species appear to reduce skin sensitivity.
• Some Limosilactobacillus species (previously known at Lactobacillus) reduce skin inflammation and improve the skin’s barrier function.
• Vitreoscilla filiformis improves the skin’s barrier function.
• Bacillus coagulans may increase free radical scavengers to fight skin aging.
• Staphylococcus hominis, S. epidermidis and Bacillus subtilis appear to suppress the growth of S. aureus.
• Streptococcus thermophilus could increase the production of ceramides

There can also be variation within each species. Research into a specific strain (denoted by an alphanumeric code after the species name) may not be applicable over the whole species.

Probiotic eczema treatments with reasonable evidence

You can read more about the science supporting both oral and topical probiotics in our focus articles or short cut to our product recommendations below. Note that probiotics are not a quick fix as it takes time of the new strains get established. You’ll need to allow 4-6 weeks before you can expect to see noticeable changes.