Over the last few months I have read more clinical studies on eczema treatments than I can count. None of them gave me much hope for my daughter or the millions of others who suffer from eczema.
One area of research that has given me hope is skin microbiota. Put simply it means the study of how the many different types of bugs that live (or should live) on our skin contribute to skin health and conditions like eczema.
Before I start on microbiota research, lets have a quick review of the treatments for eczema all of which have been studied in depth and lead me to be quite despondent. I have included a comprehensive reference section at the bottom for those who like to read all the evidence for themselves. Just google the research title to find the report.
- Moisturisers – Essential but only seem to check eczema in mild cases
- Topical Steroids – Great at suppressing the symptoms but have side effects especially when used long term
- Immune Suppressants – Studies show they are effective but there is a question mark over their long term safety
- Elimination diets – Work for some if you can identify all allergies but do not benefit most.6
- Supplements – I won’t cover them all but systematic reviews show none of them have enough evidence to recommend them7
- Oral Probiotics – Some evidence that taking certain oral probiotics in pregnancy and the first year reduces the risk of developing eczema. However a Cochrane review found there was insufficient evidence that oral probiotics would improve eczema once it has developed.8 & 9
- Antiseptics and Microbial reducing bath additives, washes and creams. Reducing staphylococcus Aureous is thought to be important in treating eczema but a Cochrane review found that none of the mainstream treatments were effective. 10
So where does the medical industry go from here. Well it seems a disappointingly small section of them are looking at topical probiotics. But the few studies or papers that have been written are interesting.
Here are a few of the things that they say:-
- “resident nonpathogenic microflora seem to stabilize the immune barrier of surface organs such as the gut or the skin.1”
- “AD is a classic inflammatory skin disorder that has long been known to be associated with dysbiosis (a state of microbial imbalance) of the surface microbial community
The combination of physical barrier and antimicrobial barrier defects likely drives the microbial dysbiosis (microbial imbalance), which disrupts further the balance of cellular immunity necessary to establish inflammatory equilibrium with the external environment” 2
- “There is rising evidence that modulating immune responses using nonpathogenic bacteria, which may even be topically administered, may be a promising treatment modality”3
- “As it could not be shown clearly that the oral intake of nonpathogenic bacteria can influence the course of AD, cutaneous application with local effects may be the strategy to be followed. Our trial confirms this new alternative rationale, which may be especially useful for patients needing a level of treatment between acute anti-inflammatory therapies and classical emollients or to prevent AD flares” 4
- “Understanding how current treatments affect bacteria and subsequent disease activity will allow us to identify and develop directed therapies for AD that will modify the skin microbiome potentially reducing the use of systematic antibiotics” 5
Some of these studies are 6 years old. Therefore one would hope to find an abundance of topical probiotics creams on the market or in use by dermatologists.
Disappointingly there are only a few probiotic creams appearing and these are mainly from the cosmetics /anti-ageing industry. None that I have found are marketed for eczema.
So far I have found
- Biotherm do a range containing Vitreoscilla filiformis which is the same thermal spring bacteria used in trials by Tubingen University in 2008 and 2014 4 & 13 but how similar they are to what was used in the trials or how suitable any of these are for eczema I don’t know.
- Aobiome Cosmetic Mist – Contains Nitrosomonas eutropha D23. Aobiome are involved in a lot of microbiota research. They chose to market this as cosmetic because to market it for medical purposes requires many years of clinical trials. I have no information about its effectiveness.
- Babytime by Episencial – Contains Lactobacillus which is more commonly used in oral probiotics. Whether Lactobacillus can survive on the skin seems to be debated but the reviews seem to be good particularly from people with eczema. I have tried this but found the tube too small and not suitable for my daughters widespread eczema.
- La Roche Lipikar Baum – Contains Vitreoscilla filiformis. This is the same bacteria used in trials by Tubingen University in 2008 and 2014. I have used this and had very good results. Using this cream I have been able to stop using steroid creams on my daughter. However the drawback is that it stings red or inflamed skin. (To see the results see my probiotic blog here)
- Avene Xeracalm Balm – This is another cream I have trialed. The results were mixed but I know others who have had good results with it. It contains Aquaphilus dolomiae which is also a bacteria in thermal springs. There has also been a study on this bacteria.11
If anybody reading this is aware of any new creams containing probiotics that are marketed for eczema please let me (Martin Burridge) know. Either leave a comment on this blog or contact me on the facebook group that I help administrate. Children living with severe Eczema, Urticaria, Asthma and Allergies
1 Roll A, Cozzio A, Fischer B et al. Microbial colonization and atopic dermatitis. Curr Opin Allergy Clin Immunol 2004; 4:373–8.
2 Dermatological Therapy by Topical Application of Non-Pathogenic Bacteria Teruaki Nakatsuji1 and Richard L. Gall
3 What is new in atopic dermatitis/eczema Sabine G Pl€otz, Markus Wiesender, Antonia Todorova & Johannes Ring† Technical University Munich, Department of Dermatology and Allergy am Biederstein (Head: Univ. Prof. Dr. med. Tilo Biedermann), Munchen, Germany
4 Effects of nonpathogenic gram-negative bacterium Vitreoscilla filiformis lysate on atopic dermatitis: a prospective, randomized, double-blind, placebo-controlled clinical study.Gueniche, B. Knaudt,* E. Schuck,* T. Volz,* P. Bastien, R. Martin, M. Ro¨cken,* L. Breton and T. Biedermann*
5 Temporal shifts in the skin microbiome associated with disease flares and treatment in children with atopic dermatitis Heidi H. Kong,1,8 Julia Oh,2 Clay Deming,2 Sean Conlan,2 Elizabeth A. Grice,2 Melony A. Beatson,1 Effie Nomicos,1 Eric C. Polley,3 Hirsh D. Komarow,4 NISC Comparative Sequence Program,5,7 Patrick R. Murray,6 Maria L. Turner,1 and Julia A. Segre
6 Bath‐Hextall FJ, Delamere FM, Williams HC. Dietary exclusions for established atopic eczema. Cochrane Database of Systematic Reviews 2008,
7 Dietary supplements for established atopic eczema Fiona J Bath-Hextall , Claire Jenkinson , Rosemary Humphreys and Hywel C Williams. Online Publication Date: February 2012
8 Probiotics in infants for prevention of allergic disease and food hypersensitivity David A Osborn and John KH Sinn . Online Publication Date: October 2007
9 Probiotics for treating eczema Robert John Boyle , Fiona J Bath-Hextall , Jo Leonardi-Bee , Dedee F Murrell and Mimi LK Tang.Online Publication Date: October 2008
10 Interventions to reduce Staphylococcus aureus in the management of atopic eczema Andrew J Birnie , Fiona J Bath-Hextall , Jane Catherine Ravenscroft and Hywel C Williams. Online Publication Date: July 2008
11 Interest of I-modulia, an Aquaphilus dolomiae extract, in innate immune response of atopic dermatitis pathologyl’ Aries, MF; Hernandez-Pigeon, H; Vaissiere, C; Caruana, A; Nguyen, T; Bessou-Touya, S; Castex-Rizzi, N 2013
13 Nonpathogenic bacteria alleviating atopic dermatitis inflammation induce IL-10-producing dendritic cells and regulatory Tr1 cells. 2014 Volz T1, Skabytska Y1, Guenova E1, Chen KM1, Frick JS2, Kirschning CJ3, Kaesler S1, Röcken M1, Biedermann T1.