Probiotics and Eczema: Exploring the Gut-Skin Axis

Atopic dermatitis is the most common form of eczema. It is an inflammatory skin condition characterised by dry, itchy skin that is prone to infection¹. In recent years, a link between gut health and eczema has been recognised, highlighting the potential of probiotics to help manage eczema symptoms². Read on to explore how probiotics may help support the gut and skin microbiomes and their potential role in eczema symptom management.

Eczema (atopic dermatitis): pathophysiology overview

The pathophysiology of eczema is driven by genetics, dysfunction of the skin barrier and the immune system.

Genetic mutations can alter the outermost layer of skin. This reduces ceramides, moisturising factors and antimicrobial peptides, resulting in increased skin pH and moisture loss. Dry, itchy skin is vulnerable to allergens and microbial invasion, particularly Staphylococcus aureus. This triggers the immune system to attack the skin, further breaking down the skin barrier and resulting in fewer fats and proteins that maintain skin barrier function, which can trigger eczema flare-ups and symptoms³.

Eczema is mainly treated with moisturisers to repair the skin barrier and anti-inflammatory agents. Newer strategies are investigating the link between the gut and the skin to help regulate inflammation and microbial imbalance, which may support symptom control and flare-ups⁴.

The gut–skin axis

The gut–skin axis describes the bidirectional communication between the gut and skin, including interactions between the gut and the atopic dermatitis microbiome.

Through our diet, we come into contact with many inflammatory mediators such as lipopolysaccharides, which can be found in high-fat meat and dairy products⁵. These enter our bloodstream through the intestine, sparking whole-body inflammatory processes and exacerbating the pathways involved in eczema flare-ups⁶.

Meanwhile, microbial metabolites produced by the gut, particularly short-chain fatty acids such as butyrate and propionate, help reduce inflammation and can enhance the skin barrier, relieving eczema symptoms⁷.

Gut dysbiosis in eczema

Gut dysbiosis refers to an imbalance in gut microbiota, often with fewer beneficial bacteria, leading to overgrowth of harmful bacteria and inflammation. This can contribute to skin barrier dysfunction and eczema flare-ups⁸.

Early colonisation of the gut microbiome relies heavily on key vaginal microbes that infants are exposed to during birth. Caesarean births reduce exposure to maternal vaginal flora, lowering beneficial bacterial colonisation and increasing the risk of gut dysbiosis. Prenatal or neonatal antibiotic use can also disrupt bacterial colonies⁹.

This link between gut health and eczema is further highlighted by the fact that early colonisation with beneficial bacteria is associated with a reduced risk of childhood eczema, which occurs more frequently in caesarean-born children¹⁰.

Probiotic strains studied in eczema

Widely studied probiotic strains for eczema include Lactobacillus rhamnosus GG (LGG) and Bifidobacterium species to help modulate the gut and skin microbiomes. LGG reduces inflammation, promotes skin barrier health through the production of short-chain fatty acids, and supports a more beneficial gut and skin microbiome profile¹¹. Bifidobacterium species may play a key role in eczema prevention by restoring early-life gut microbiota balance, reducing inflammation and supporting skin barrier health¹².

Multi-strain probiotic formulas mimic the diverse gut microbiome population and may offer complementary benefits. For example, LGG’s anti-inflammatory and skin barrier repair effects may be enhanced by Bifidobacterium properties. These formulas can better address dysbiosis across the gut and skin, and may potentially help control eczema flare-ups¹³.

The best probiotic products for managing eczema: what does the clinical evidence show?

Lactobacillus-based probiotics

• Lactobacillus rhamnosus GG (LGG): After 12 weeks of daily use, children aged 6–36 months experienced fewer eczema flare-ups and improvements in both their gut and skin microbiome populations¹¹.
• Lactobacillus rhamnosus HN001: When taken by mothers from late pregnancy, around 35 weeks, through 6 months of breastfeeding, and by their children from birth to age 2, this probiotic lowered the long-term risks of eczema, allergies and hay fever up to age 11¹⁴.
• Lactobacillus salivarius LS01: Adults who took this probiotic daily for 16 weeks showed fewer eczema symptoms, a healthier gut microbiome and reduced inflammation compared with those taking a placebo¹⁵.
• Lactobacillus acidophilus: Adults over the age of 16 who took oral probiotics for 8 weeks experienced improved eczema symptoms and inflammation¹⁶.

Other single-strain probiotics

• Bifidobacterium longum: Children aged 3–12 months used the oral probiotic alongside antihistamines and emollients for 8 weeks. This led to a 60% reduction in eczema symptoms, an improved gut microbiome and reduced inflammation¹⁷.
• Roseomonas mucosa: In children under 7, topical application improved the skin barrier, lowered Staphylococcus aureus levels, reduced the need for steroids, and improved gut and skin microbiomes for up to 8 months after treatment¹⁸.

Mixed-strain probiotics

• Lactobacillus paracasei LPC-37, Lactobacillus rhamnosus HN001, Lactobacillus acidophilus NCFM and Bifidobacterium lactis HN019: Daily supplementation in children aged 6 months to 19 years with eczema over 6 months led to improved symptoms¹⁹.
• Lactobacillus rhamnosus LC705, Bifidobacterium breve Bb99 and Propionibacterium freudenreichii ssp. shermanii JS: In caesarean-delivered children, daily perinatal probiotics resulted in fewer children developing eczema²⁰.
• Bifidobacterium longum, Lactobacillus acidophilus and Enterococcus faecalis: Eczema symptoms significantly improved after 4 months in infants up to 11 months old²¹.
• Bifidobacterium lactis CECT 8145, Bifidobacterium longum CECT 7347 and Lactobacillus casei CECT 9104: After 12 weeks of probiotic use, the need for topical steroids to treat eczema flare-ups was reduced²².

Safety and clinical considerations

Probiotic strains for eczema are generally safe for most people. However, they can interact with the host’s existing microbiota, occasionally causing mild gastrointestinal symptoms such as bloating or discomfort. Clinical evidence indicates that not all probiotic strains are equally effective. Some strains appear effective at preventing or managing eczema symptoms, while others show little to no change².

In certain high-risk populations, including those who are immunodeficient, neonates or those with severe health issues, probiotics should be used with caution. There have been rare but serious reports of allergic reactions²³, bacterial or fungal infection, and even sepsis²⁴.

Practical considerations for HCPs

When recommending probiotics for eczema, patient safety should be prioritised. Probiotics are generally safe for low-risk, healthy individuals, but should be avoided in patients who are severely immunocompromised, are ill or have multiple risk factors²⁵.

For eligible patients, the potential effectiveness of probiotics may depend on the strain and quality control. Recommended probiotics should have peer-reviewed clinical evidence with verified colony-forming units (CFUs) to support potency claims²⁶. The quality, dose and duration of use are critical and may determine how effective the probiotic will be.

Probiotics may have a valuable role alongside standard eczema creams and anti-inflammatory treatments. They have been shown to be particularly effective for the prevention of eczema or in cases where underlying gut dysbiosis is identified as a driver of systemic inflammation²⁴.

Finally, managing patient expectations is essential. Any potential symptom improvement will not be immediate and may take a few weeks or months, depending on the specific strain and dosage²⁴. Regular monitoring and follow-up assessments are vital to ensure the treatment is working, identify any side effects early, and improve outcomes.

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