Probiotics For Eczema: A New Perspective on Skin Health

Eczema is a joint group of skin conditions that causes dry and itchy patches of skin. One type of this skin condition is also known as atopic dermatitis since it involves skin inflammation that commonly flares up when you come into contact with an irritant or an allergen. It impacts around 15-30% of children and 2-10% of adults worldwide.

To effectively address eczema in the long term, it is essential to identify and treat the underlying causative factors. While multiple underlying pathologies can contribute to the skin inflammation seen in eczema, a growing body of evidence shows that a significant component of the underlying root cause of eczema stems from gut dysfunction and microbiome imbalances in the gut and skin.

Probiotics provide beneficial organisms that support the balance of microbes and immunity in the gut and other body areas, like the skin. Probiotics for eczema treatment have been widely studied and shown to improve skin inflammation and patients’ quality of life. 

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What is Eczema?

Eczema refers to several chronic conditions, including atopic dermatitis, contact dermatitis, dyshidrotic eczema, neurodermatitis, nummular eczema, and seborrheic dermatitis, all involving skin inflammation. It is the most common chronic skin disease worldwide. It is common for eczema to begin in childhood and persist into adulthood, with relapsing episodes of skin inflammation. Only around half of the 10-20% of infants with eczema outgrow it as they mature.

Eczema can cause varying degrees of symptoms, ranging from mild dry patches of skin to intense itching, pain, and thickened skin. Eczematous skin can appear red, pink, purple, brown, or gray, depending on skin tone, with a flaky and bumpy texture. This inflammation can occur anywhere on the body but is most common on the face (cheeks, forehead, and around the mouth) in infants and on the extensor surfaces of the wrists, elbows, ankles, and knees in older children. In adults, eczema commonly occurs on the flexural surfaces of the elbows and knees.

Because of the intense itching and skin breakdown, eczema can significantly impact a person's quality of life. People with eczema commonly experience sleep disturbances, emotional distress, and an increased risk of skin infections.

This inflammatory condition weakens your skin’s barrier function, which usually helps your skin retain moisture and protect you from the outside world. In some cases, the skin barrier is weaker due to genetics. Eczema is most common in people with a family history of eczema, dermatitis, asthma, and allergies. 

The skin barrier can also become disrupted due to an imbalance of bacteria on the skin’s surface, with reduced numbers of beta-defensins in the skin, which protect the skin against infectious agents, and too much of the bacteria Staphylococcus aureus crowding out healthy microbes on the skin. With this weakened protection, the skin is less able to retain moisture and protect against irritants, allergens, environmental factors like tobacco smoke, and harmful bacteria. The immune response can become imbalanced. As the skin barrier, skin microbiome, immune response, and inflammation throughout the body become imbalanced, it can result in dry, itchy, and bumpy skin.

Gut-Skin Axis: Connecting Digestive Health and Skin

The gut-skin axis describes how your skin and gastrointestinal tract are closely intertwined and influence each other bidirectionally. Both your gastrointestinal tract and skin are inhabited by many microorganisms. You acquire your unique microbiomes at birth, which are altered and changed throughout your life from exposure to your environment, medications, foods, and more.

The gut-skin axis is mediated by influences on your immune system and inflammatory mediators released into the bloodstream. For example, the microbes in your gut microbiome influence signaling processes that help keep cells healthy to maintain the integrity of their barrier function and average skin turnover. Skin microbes also send signals to the immune system and gut. 

The microbiome can get out of balance (dysbiosis) due to various environmental factors, such as stress, diet, medications, and toxins, especially with exposures early in life. If the microbial balance is altered, communication with the immune system can become impaired, triggering increased inflammation in the gut, skin, and throughout the body. This is due in part to signaling molecules like short-chain fatty acids (SCFAs) (butyrate, propionate, and acetate) that your gut bacteria can produce, which have anti-inflammatory and immunomodulatory effects.

Given this gut-skin connection, research shows that the composition of the gut microbiome is associated with inflammatory skin conditions like eczema. Studies have shown that microbial dysbiosis impacts the age of onset, severity, remission, flares, and subtype of eczema a person experiences. Specifically, people with eczema have higher levels of Clostridium difficile, Escherichia coli, and Staphylococcus aureus in their guts with lower levels of Bifidobacteria, Bacteroidetes, and Bacteroides types of bacteria.

What Are Probiotics?

Probiotics are foods or supplements consisting of beneficial organisms such as bacteria and yeasts that are taken to support and enhance a healthy balance of microbes in your body. In addition to commercially-available supplements containing different strains of microbes, fermented foods like yogurt, kefir, sauerkraut, and kombucha contain naturally occurring probiotics. 

Probiotics help to reestablish balance in a healthy microbiome by inhibiting the growth of problematic microorganisms, repopulating beneficial microbes, and supporting the development of beneficial commensal organisms. In addition, probiotics can directly influence the immune system to help favorably modulate inflammatory responses and interact with the nervous system to impact signaling. 

Probiotics can also help to heal and improve the intestinal barrier. The gut barrier is an essential protection between the outside world and your body. This barrier must remain intact via the maintenance of tight junctions that keep out harmful microbes, toxins, and other substances. Probiotics can influence these tight junctions between these cells and restore the standard mucus layer to help maintain a solid gut barrier. This contributes to their ability to modulate the immune system, prevent allergic responses, and reduce inflammation. 

In addition to supporting the intestinal barrier function, probiotics help to modulate the immune system by increasing the production of secretory IgA (SIgA). SIgA is crucial for protecting the body from pathogens and toxins that enter the gut. Probiotics can also impact other cells of the immune system and influence inflammatory cytokines that enhance immune function. 

Research on Probiotics and Eczema Management

These benefits of probiotics on the immune system, gut, allergic reactions, and inflammatory response make them valuable for treating various health conditions, including those that impact the skin. Clinical evidence for probiotics in skin health supports their use both orally and topically for a variety of inflammatory skin conditions. 

Research supports the use of probiotics taken orally and/or applied topically to treat various skin diseases, including eczema. Taking probiotics can help to rebalance microbiomes in the gut and skin to heal the heart and skin barrier, help balance the immune response, prevent the overgrowth of pathogenic bacteria, and reduce inflammation. Together, these impacts are beneficial for healing the underlying factors that contribute to the development of eczema.

Oral probiotics treatment in infants significantly reduces the development of eczema. This benefit is most striking in those with established IgE-mediated allergies. Probiotics can also help prevent allergic phenomena like eczema in cesarean-delivered children who are at a higher risk of these conditions. Similarly, studies have found that giving probiotics to breastfeeding mothers can safely prevent eczema.

Utilizing topical probiotics to balance the skin microbiome, immune response, and inflammation is also a valuable strategy for dealing with eczema. Topical probiotics have been shown to reduce skin inflammation and improve symptoms of eczema. A double-blind, placebo-controlled trial utilized topical application of a strain of bacteria found on healthy skin (Staphylococcus hominis A9) in patients with moderate to severe eczema. Two-thirds of study participants had significant improvements in their eczema symptoms, including reduced itching and inflammation. The scientists found that this strain of beneficial, healthy skin bacteria helped to crowd out and kill excess Staphylococcus aureus that is common on the skin of people with eczema.

How to Incorporate Probiotics into Eczema Management

Using probiotics for eczema can clearly have many potential benefits. Certain strains of beneficial bacteria have specifically been studied to benefit the inflammation that occurs in eczema. 

For example, supplementation with Lactobacillus rhamnosus together with Lactobacillus reuteri improved skin symptoms in children with eczema. Supplementation with Lactobacillus rhamnosus has also been shown to reduce the development of eczema in children when given to women who were breastfeeding prenatally. Another type of Lactobacilli probiotic, L. casei, targets inflammatory cytokine pathways to reduce skin inflammation. 

In addition to targeted supplementation with oral probiotics, topical probiotics have been shown to improve eczematous skin reactions. Topical probiotics are beneficial organisms that can be applied directly to the skin to balance the microbes. Studies have shown that modifying the skin microbiome in this way reduces disease severity and increases the quality of life in children with eczema. This treatment was safe and well tolerated in children as young as three years of age.

In addition to oral and topical probiotic supplements, dietary sources of probiotics can also help the body come into balance. Foods like asparagus, garlic, onions, artichokes, chicory, leafy green veggies, berries, legumes, oats, cooked and cooled rice and potatoes, green bananas, plantains, cashews, quinoa, seeds, tea, and cocoa are rich in prebiotic fibers to feed healthy bacteria while naturally probiotic-rich fermented foods like kimchi and sauerkraut enhance the health of the gut microbiome.

Safety and Considerations in Probiotic Use

Like everything in integrative medicine, there is no one-size-fits-all approach to probiotic use. There are several considerations in probiotic use to consider in cooperation with your healthcare provider, so it is always essential to consult a professional before starting probiotic supplements, especially when you have underlying health conditions. Although probiotics have an extensive history of safe use, their safety needs to be considered on an individual basis. 

For example, cases of severe fatal infections have been reported in premature infants who were given probiotics, so those with immunocompromised or other severe illnesses should use caution. 

There are many different strains and combinations of strains of probiotics available on the market. Other types of probiotics can have different effects. As discussed above, Lactobacilli and Bifidobacterium species are the most commonly used probiotics for reducing skin inflammation in eczema, but your supplementation regimen should be tailored to your unique microbiome at this point in your life. Utilizing clinical information and/or targeted functional medicine testing, your clinician can help tailor an individualized approach to probiotic use that meets your unique body and needs.

Integrating Probiotics with Other Eczema Treatments

A holistic approach to eczema management can help balance the body by recognizing and addressing the patient’s unique health needs. Probiotics can be integrated into a comprehensive management strategy along with conventional and alternative eczema treatments. Combining probiotics, lifestyle, traditional medications, and dietary changes in an individualized plan provides synergistic benefits that can more effectively manage symptoms and improve quality of life.

Given the close connections between the skin, gut, and immune system via the gut-skin axis, dietary strategies are a crucial component of an integrated approach to eczema management. Addressing imbalanced gut bacteria, food allergies, and/or leaky gut can help reduce the inflammation and allergic reactions underlying eczema. For example, dysbiosis and food allergies and sensitivities can trigger an inflammatory immune response. Both IgE- and IgG-mediated reactions to foods like dairy, gluten, and eggs can contribute to eczema.

An anti-inflammatory diet personalized to eliminate any IgE- and IgG-mediated food allergies and sensitivities will help reduce systemic inflammation in your body and allow the microbiome, intestinal barrier, and skin to start to heal. This way of eating emphasizes a variety of whole plant-based foods that contain prebiotics, probiotics, antioxidants, and fiber and remove processed sugars, fats, and carbohydrates. 

Anti-inflammatory herbs and spices like turmeric help to heal the gut, favorably modulate the microbiome, ease inflammation, and provide antioxidant protection. Curcumin found in turmeric has been shown to heal inflammation both in the gut and skin. The bioavailability of curcumin in turmeric is relatively low even when combined with black pepper for increased absorption, so supplementation in doses up to 2,000 mg a day may be utilized.

Stress worsens inflammation in the gut and skin and can contribute to flares of eczema. Incorporating a regular stress management practice can help you reduce excess cortisol and inflammation to reduce symptoms of eczema. Yoga, meditation, breathwork, prayer, spending time in nature, and other mind-body practices help shift your body into the parasympathetic response that allows for gut and skin healing.

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Probiotics For Eczema: Key Takeaways

Eczema is a chronic inflammatory skin condition that affects many children and adults. The dry, itchy skin this condition creates can significantly impact the quality of life. 

A multifaceted approach to inflammatory skin conditions like eczema recognizes the intricate connections between the skin and the gut that are primarily mediated by microbes residing in both locations. These microorganisms communicate with each other via the gut-skin axis and have wide-reaching effects on the immune system and inflammation. 

Adopting a holistic strategy for eczema management allows you to address underlying imbalances and use an individualized management plan to bring your body back into balance. Oral and topical probiotics offer promise as part of a comprehensive approach to skin inflammation in eczema. Probiotic supplementation can be part of a personalized approach integrated with dietary, lifestyle, and conventional medical management to heal the gut and skin.