Understanding Eczema
Eczema, particularly atopic dermatitis, is a chronic inflammatory skin condition characterized by dry, itchy, red, and irritated skin. It affects approximately 15-20% of children and 1-3% of adults worldwide, making it one of the most common dermatological conditions. While often beginning in infancy or early childhood, eczema can persist into adulthood or develop later in life.
The condition results from a complex interplay of genetic, environmental, and immunological factors. People with eczema typically have impaired skin barrier function, allowing allergens and irritants to penetrate more easily and moisture to escape. Their immune systems also tend toward exaggerated inflammatory responses, particularly involving T-helper 2 (Th2) cells and associated cytokines like interleukin-4 and interleukin-13.
Eczema often occurs alongside other atopic conditions, including asthma, allergic rhinitis, and food allergies, a phenomenon known as the “atopic march.” This clustering suggests shared underlying mechanisms, and research increasingly points to the gut microbiome as a common factor influencing all these conditions.
The Gut Connection in Eczema
The relationship between gut health and eczema has become a major focus of research over the past two decades. Studies consistently show that infants who develop eczema have different gut microbiome compositions in the months before symptoms appear, suggesting that microbial imbalance may precede and contribute to disease development.
Specifically, children who develop eczema tend to have lower diversity of gut bacteria and reduced levels of Bifidobacterium and Lactobacillus species during early life. They may also have higher levels of certain potentially harmful bacteria. This pattern of dysbiosis appears to influence immune development, potentially promoting the Th2-dominant immune responses characteristic of atopic conditions.
The gut microbiome shapes immune function through multiple mechanisms. Beneficial bacteria help “train” the developing immune system to distinguish between harmful pathogens and harmless substances. When this process is disrupted, the immune system may become hyperreactive, responding to environmental triggers that shouldn’t provoke inflammation. The result can be conditions like eczema, where the immune system overreacts to minor stimuli.
How Probiotics May Help
Probiotics offer several potential mechanisms for supporting eczema management, particularly by addressing the immune dysregulation at the condition’s core.
Immune Modulation: Probiotics interact with immune cells in the gut-associated lymphoid tissue (GALT), influencing systemic immune responses. Certain strains can shift immune balance away from Th2 dominance toward a more balanced state, potentially reducing the allergic-type inflammation seen in eczema.
Strengthening Skin Barrier: Although taken orally, probiotics can influence skin barrier function systemically. By reducing inflammation and supporting the production of beneficial metabolites like short-chain fatty acids, probiotics may help improve the skin’s ability to retain moisture and resist irritants.
Reducing Systemic Inflammation: Chronic inflammation drives eczema flares and perpetuates the condition over time. Probiotics help modulate inflammatory cytokine production and support regulatory T-cells that keep immune responses in check.
Supporting Gut Barrier Function: Intestinal permeability may play a role in sensitization to allergens. By strengthening tight junctions between intestinal cells, probiotics reduce the likelihood of large protein molecules crossing the gut barrier and triggering immune responses.
Research Highlights
A landmark study published in The Lancet in 2001 examined whether Lactobacillus rhamnosus GG supplementation during pregnancy and early infancy could prevent eczema development. Researchers found that the probiotic group had significantly lower rates of eczema at age 2 compared to placebo, suggesting potential for primary prevention.
Research published in the Journal of Allergy and Clinical Immunology in 2010 conducted a meta-analysis of probiotic studies in eczema. The analysis found that probiotics significantly reduced eczema severity scores, particularly in moderate to severe cases, with Lactobacillus species showing the most consistent benefits.
A 2012 study in Pediatric Allergy and Immunology examined Lactobacillus reuteri supplementation in infants with eczema. Over 6 months, the probiotic group showed significant improvements in eczema severity (SCORAD index) compared to placebo, along with changes in inflammatory markers.
The World Allergy Organization published guidelines in 2015 suggesting that probiotics may be considered for preventing eczema in high-risk infants, citing moderate-quality evidence for this application. This represents one of the strongest professional recommendations for probiotic use in a specific condition.
Strains That May Help
Lactobacillus rhamnosus GG is the most extensively studied strain for eczema, with research spanning prevention in infants and treatment in established cases. It has demonstrated immune-modulating properties and improvements in eczema severity scores across multiple trials.
Bifidobacterium lactis supports gut barrier function and immune balance. Studies have shown benefits when used alone or in combination with other strains for both preventing eczema development and reducing severity in existing cases.
Lactobacillus reuteri has demonstrated anti-inflammatory properties and improvements in eczema outcomes in pediatric studies. Its ability to colonize the gut effectively and produce antimicrobial substances contributes to its potential benefits.
Dosage Considerations
Research on probiotics for eczema has used a wide range of doses, typically from 1 billion to 10 billion CFU daily. Pediatric studies often use lower doses appropriate for children’s body weight and developing systems.
For eczema prevention in infants, some protocols begin probiotic supplementation during pregnancy (last trimester) and continue through breastfeeding or directly to infants for the first 6-12 months of life. Treatment studies in children and adults typically use 8-12 week supplementation periods.
A multi-strain formula containing Lactobacillus rhamnosus, Bifidobacterium lactis, and potentially Lactobacillus reuteri at combined doses of 5-10 billion CFU is commonly recommended for eczema support. Always consult a healthcare provider before giving probiotics to infants or using them during pregnancy.
Lifestyle Factors
Comprehensive eczema management involves multiple supportive measures:
- Moisturize frequently using fragrance-free emollients to support barrier function
- Identify and avoid triggers which may include certain foods, environmental allergens, or irritants
- Maintain optimal bathing practices with lukewarm water and gentle, soap-free cleansers
- Manage stress which can trigger or worsen eczema flares
- Consider dietary factors such as reducing processed foods and ensuring adequate omega-3 fatty acids
- Keep nails short to minimize damage from scratching
- Choose soft, breathable fabrics like cotton and avoid wool or synthetic materials against the skin
- Maintain comfortable humidity levels in living spaces, especially during winter
When to Seek Medical Advice
While probiotics may support eczema management, medical care is essential in several situations:
- Severe eczema covering large body areas or significantly impacting quality of life
- Signs of skin infection including increased redness, warmth, oozing, or crusting
- Eczema not responding to basic skincare and over-the-counter treatments
- Sleep disruption due to itching
- Eczema in infants under 3 months of age
- Before starting probiotics in infants, during pregnancy, or in immunocompromised individuals
- When considering probiotics as part of a comprehensive treatment plan
A dermatologist or allergist can provide appropriate prescription treatments, identify potential triggers through testing, and help develop an individualized management strategy that may include probiotics as one component.
Key Takeaways
- Eczema is a chronic inflammatory skin condition involving impaired barrier function and immune dysregulation
- Gut microbiome differences precede eczema development, suggesting gut health plays a causative role
- Infants who develop eczema often have reduced diversity and lower levels of beneficial bacteria
- Probiotics may help eczema by modulating immune responses, reducing inflammation, and supporting both gut and skin barrier function
- Lactobacillus rhamnosus GG has the strongest evidence base for eczema prevention and treatment
- The World Allergy Organization suggests probiotics may be considered for eczema prevention in high-risk infants
- Doses of 5-10 billion CFU daily are commonly used, with treatment periods of 8-12 weeks
- For prevention, supplementation may begin during pregnancy and continue through early infancy
- Probiotics work best alongside proper skincare, trigger avoidance, and appropriate medical treatment
- Consult a healthcare provider before using probiotics in infants, during pregnancy, or for severe eczema