Probiotics for eczema: Do they really work?
Dry, itchy skin can be debilitating — so should you consider probiotics for eczema and do they really work?
Do probiotics for eczema really work? The use of them for this purpose is being researched, but first, it’s important to understand what eczema is. Also known as atopic dermatitis, eczema is a common inflammatory skin condition thought to affect 7-11% of American adults. It usually shows up as dry, itchy skin but it also can cause rashes, blisters and skin infections.
There is no cure for eczema, but there are ways to ease the symptoms. A daily bath and moisturizing routine can help, although avoid overexposure if water is one of the triggers. Moisturizers containing humectants like glycerin and hyaluronic acid, as well as emollients such as squalene, ceramides and fatty acids and alcohols, can help too.
But what about the best probiotics? Studies suggest that the skin microbiome in those with eczema is often lacking certain good bacteria. Topical probiotics have therefore been suggested as a potential treatment. But is there any evidence to support their success? We asked the experts.
What causes eczema?
“No one knows what causes eczema,” says Dr Sandra Johnson, an American Board of Dermatology certified dermatologist. “It’s an allergy of the skin, similar to asthma of the lungs. The skin barrier is affected and many things irritate the skin.”
Sandra Marchese Johnson received her certification from the American Board of Dermatology in 2000, 2010 and 2020. She graduated from Northeastern Ohio Universities College of Medicine in 1996. After residency at UAMS, she served as the UAMS Director of Dermatology Clinical Trials and supervisor of cosmetic training for dermatology residents.
As the skin barrier is impaired, the permeability is increased, according to the journal Experimental and Therapeutic Medicine, and there is a greater risk of allergic sensitization, such as inflammation or flare-ups, and lower protection against resident microbes. This results in an overactive immune system that causes the skin to become dry.
Eczema develops because of an interaction between genes and environmental triggers, states the National Eczema Association. There’s an increased likelihood of developing eczema if one or both of your parents have it, or other siblings. Women may also experience flare-ups due to hormonal changes.
Environmental triggers can include common household items and environments such as:
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- Soaps, shampoo, body wash, bubble bath
- Laundry detergents and fabric softeners
- Cleaners and disinfectants
- Candle fragrances
- House dustmites
- Pet fur
- Dampness
- Exposure to dry air, extreme heat or cold over extended period of time
- Fruit and vegetable juice
- Food allergies, such as to milk, peanuts, soy, eggs
What does science say about taking probiotics for eczema?
The bacteria in our bodies are unique to us: no two humans have an identical intestinal microbiome, according to the Experimental and Therapeutic Medicine journal. Similarly, we have different strains of bacteria on our skin, and what we ingest or apply topically can affect the skin microbiome.
Nature Reviews Microbiology reports that people with eczema often lack the good bacteria in their skin microbiome — and probiotics may help with that. Probiotics are living micro-organisms that stimulate the growth of specific bacteria while killing off other bacteria.
“Because the skin barrier and microbiome are altered, probiotics should help atopic dermatitis,” says Johnson. “In fact, a new topical medicine Vtama (tapinarof) is being studied for atopic dermatitis. It normalizes the barrier and microbiome.”
Tapinarof is a topical cream that can be applied to the skin, while many probiotics are taken orally. There’s some evidence that probiotics may help with eczema, though much is still unknown. Researchers are still looking into optimal dosing of probiotics, how long you’d need to take them and when would be the best time to start.
A recent review in the Journal of Dermatological Treatment looked at 21 studies of probiotic use during pregnancy and in children. Researchers found a lower risk of eczema when probiotics were used, especially with babies under the age of two.
A 2014 review published in the Annals of Allergy, Asthma, and Immunology, including 25 trials, also suggested that probiotics could be an option for children and adults with moderate to severe eczema, but they found no evidence for its use for infants.
While other research reviews have found little or no difference in eczema severity when using probiotics, for people of all ages. Researchers agree there can be conflicting data and results on what the science is currently saying about the use of probiotics.
How else can you treat eczema?
“Right now, good skin care is important for avoiding irritation,” says Johnson. “Keep the skin well-hydrated.”
To manage eczema flares, the National Eczema Association recommends implementing a daily bathing and moisturizing routine. Moisturizing can be done with regular over-the-counter creams recommended by dermatologists or with prescription topical medicals, such as corticosteroids.
Johnson says that mostly topical steroids are used to treat eczema, but these have side effects. Steroids for eczema can reduce inflammation and itching, allowing for the skin to heal but, once the flare-up is under control, steroid use should be stopped or reduced, using your physician’s instructions. Common side effects of steroids used as cream on the skin include:
- Rashes
- Thinning of the skin
- Spider veins
- Stretch marks
- Acne
- Changes in skin color
- Increased hair growth
There may also be more serious side effects and conditions that can arise as a result of steroid use, including cataracts, glaucoma, and topical steroid withdrawal. The risk of side effects from using these creams may be increased if used for many months, in large amounts, or on places of the body that are especially sensitive, such as the arm, armpits, and groin.
People that experience eczema should be aware of what their environmental and product triggers are. Avoid exposure to these conditions or swap out products for more skin-friendly options, such as fragrance-free laundry detergent. As food allergies can also trigger eczema flare-ups, check with a physician or dietitian about potential allergies and ways to make changes to your diet.
The UK’s National Health Service also recommends using antihistamines to relieve itching and bandages or body suits to allow the skin to heal underneath. Self care is also important: ensuring that you’re cognizant about scratching and the damage being done to your skin. Intense scratching can cause wounds that can mean infection and scarring.
To keep the skin well moisturized throughout the day, keep tubs of dermatologist-recommended lotions and creams around the home, as well as at work or in the car, if applicable. Be generous with lotion use, preferably at least twice a day, and use it after a bath or shower while the skin is still moist – locking water onto the skin with the moisturizer.
This article is for informational purposes only and is not meant to offer medical advice.
Lindsay Lafreniere is a freelance writer, editor and podcast producer. Lindsay has more than eight years’ experience working in communications, journalism and media relations, including in corporate, non-profit, government, hospital and university environments. Lindsay has worked for various media including broadcasting at the CBC, and in documentary production and magazine publishing at the Walrus, and has also held positions in academic and government communications and corporate online marketing. Lindsay received a bachelor’s degree in Psychology and English from Victoria University in Canada and a Graduate Diploma in Journalism from Concordia University.