ATOPIC dermatitis (AD) is a chronic inflammatory skin condition that significantly impacts patients’ quality of life. It is characterised by recurrent eczematous lesions and severe itching, often requiring extensive management and medical intervention. The prevalence of AD is estimated at 15–20% in children and 1–3% in adults, with incidence rates increasing in industrialised nations. In most cases, AD manifests during early childhood, with spontaneous remission occurring in approximately 60% of cases during adolescence. AD is also part of the atopic triad, which includes asthma and allergic rhinoconjunctivitis.
The pathogenesis of AD is multifactorial, involving genetic predisposition, immune system dysfunction, skin barrier impairment, and environmental factors. A primary mechanism underlying AD is the compromised skin barrier, which triggers inflammatory responses and allergic sensitisation. Observational studies suggest a strong genetic link, with higher concordance rates observed in monozygotic twins compared to dizygotic twins. Additionally, environmental factors such as pollution, urban living, diet, and microbiota alterations play crucial roles in AD development.
Recent research highlights the role of gut microbiota in AD pathogenesis. Patients with AD exhibit reduced microbial diversity, particularly lower levels of beneficial bacteria such as Lactobacillus and Bifidobacterium. This dysbiosis is observed early in life, reinforcing the hypothesis that gut microbiota imbalances contribute to AD. The composition of the microbiota is influenced by various factors, including maternal microbiome, mode of delivery, breastfeeding, and antibiotic exposure.
Probiotics, particularly Bifidobacterium bifidum PRL2010, have shown potential in modulating immune responses and restoring microbial balance. Studies indicate that probiotics enhance Th1 immune responses while reducing Th2-mediated allergic reactions, thereby promoting immune tolerance. Although clinical trials on probiotics for AD prevention yield mixed results, some findings suggest that probiotic supplementation during pregnancy and breastfeeding may reduce AD severity in offspring.
While our study did not demonstrate a statistically significant reduction in AD incidence, children receiving probiotics exhibited milder disease manifestations. Larger-scale research is necessary to validate these findings and establish probiotics as a definitive strategy for AD prevention and management. Nonetheless, probiotics remain a promising avenue in alleviating AD symptoms and improving patient outcomes.
Katie Wright, EMJ
Reference
Anania C et al. Effect of supplementation with a specific probiotic (Bifidobacterium bifidum PRL2010) in pregnancy for the prevention of atopic dermatitis in children: preliminary results of a randomized trial. Nutrients. 2025;17(4):673.
