Eczema, or atopic dermatitis, is a chronic inflammatory skin condition affecting up to 20% of the global population. The causes of eczema are multifactorial with treatments aimed predominately at reducing inflammation and improving the skin barrier, often with moisturisers and anti-inflammatories.[1,2] Natural therapists often incorporate internal probiotic supplementation into the eczema regime, respecting the gut-skin axis, but what is commonly overlooked is the impact the microbiome residing on the skin’s surface has on eczema development and progression.
Staphylococcus, Corynebacterium and Propionibacterium are the main bacterial species residing on the skin, with 90% made up of Staphylococcus epidermis. This bacterium plays an important role as an antimicrobial and actively contributes to the skin’s innate immune defense. However, approximately 90% of eczema sufferers have pathogenic overgrowth of Staphylococcus aureus, which produces a toxin that causes immunological and structural dysfunctions of the skin, leading to eczematous flares and infections.[2,4]
Because of this microbial imbalance, decolonisation through the use of antibiotics is often recommended; however, a Cochrane review found no clinical benefit of this therapy on eczema. This led researchers to propose that directly stimulating the growth of the beneficial bacteria on the skin, S. epidermis, through the use of an external probiotic, iBiotics™ AU Lactobacillus brevis (DSM 17250), would be an important and novel way to manage eczema.
In a 2017 randomised placebo-controlled trial, L. brevis (DSM 17250) was tested for its ability to change the microbial diversity, reduce inflammation and provide structural and symptomatic improvements to eczematous skin.
L. brevis (DSM 17250) produces small molecules capable of enhancing the growth of skin commensals. This was confirmed by in vitro tests, with this probiotic having the strongest growth promoting activity against nine strains of S. epidermis, compared to three other strains of L. brevis. Further analysis also showed significant anti-inflammatory effects.
In vivo skin testing on 30 healthy volunteers with dry skin for four weeks, showed L. brevis (DSM 17250) was effective in significantly recolonising the skin with S. epidermis and other commensal bacteria, while severely reducing S. aureus in subjects with high baseline levels.
Additionally, the externally applied probiotic improved skin barrier function, reducing transepidermal water loss, with around a 70% improvement in skin tightness, roughness, scaling and sensitivity over the four weeks.
The researchers concluded that this probiotic, used externally, provides a powerful and gentle solution to treat skin conditions. It specifically and beneficially shapes the skin microbial community, while moisturising and improving skin barrier function.
- Lee JH, Son SW, Cho SH. A comprehensive review of the treatment of atopic eczema. Allergy Asthma Immunol 2016;8(3):181-190. [Full text]
- Chong M, Fonacier L. Treatment of eczema: corticosteroids and beyond. Clin Rev Allergy Immunol 2016;51(3):249-262. [Abstract]
- Holz C, Benning J, Schaudt M, et al. Novel bioactive from Lactobacillus brevis DSM17250 to stimulate the growth of Staphylococcus epidermidis: A pilot study. Benef Microbes 2017;8(1):121-131. [Full text]
- Vieira BL, Lim NR, Lohman ME, et al. Complementary and alternative medicine for atopic dermatitis: an evidence-based review. Am J Clin Dermatol 2016;17(6):557-581. [Abstract]