Eczema is a stubborn and confusing skin problem. Doctors usually prescribe corticosteroid creams that come with side effects, and many people are searching for safer alternatives. Yet, the available OTC and “natural” lotions provide little to no relief. Could oral probiotics be part of the solution? This post takes a detailed look at the latest research to help you understand when probiotics won’t do much and when they might actually help.
Disclaimer: This post is for informational purposes only. Please discuss your health concerns with your care provider and consult them before taking any supplements to avoid disease and drug interactions.
How Your Gut Bacteria May Cause Eczema
The Enigma of Eczema
If you or someone you know well has suffered from eczema, you know you perplexing the search for potential triggers and solutions can be. Eczema affects up to two in 10 children and 1–3% of adults. It’s also known as atopic dermatitis and is classified as a chronic inflammatory skin condition.
Eczema is accompanied by itching, which causes painful skin irritation, soreness, and difficulty sleeping and getting about your day.
So, what can your gut microbiome have to do with it?
The Gut-Skin Axis
Thanks to new research, we now know that the bacteria in your gut can affect anything from your mental health to skin health to immunity. Imbalances in the gut microbiome can have a ripple effect on these systems. When gut health impacts the skin, we’re talking about the gut-skin axis (Hills Jr et al, 2019).
Studies reveal that gastrointestinal disorders are linked with skin diseases. For instance, people with IBD are more likely to also suffer from psoriasis. Meanwhile, many people with eczema have food allergies due to “leaky gut” or permeability of the small intestine (Pessemier et al., 2021; Sodre et al., 2022)
Scientists hypothesize that by nourishing the gut microbiome, the skin microbiome can also be improved.
The Eczema Skin Microbiome
Patients with eczema have a highly abnormal imbalance of skin bacteria.
The hallmarks are less microbial diversity, fewer beneficial bacteria, and an overgrowth of “bad” bacteria like Staphylococcus aureus. This causes the skin barrier to become “leaky” and vulnerable, triggering inflammation (Hrestak et al, 2022; Sodre et al., 2022).
Bifidobacterium and Lactobacillus probiotics can tighten the junctions between cells, strengthening the skin barrier (Marras et al., 2021).
The Eczema Gut Microbiome
It’s not just the skin—patients with eczema are prone to gut dysbiosis.
They have more “bad” gut bacteria (like Clostridium and Staphylococcus of the Firmicutes phylum) than healthy people (Sodre et al., 2022).
Eczema patients also lack the “good” gut bacteria that help produce short-chain fatty acids (SCFAs). SCFAs are anti-inflammatory and maintain gut barrier integrity (Kim & Kim, 2019).
Th1/Th2/Th17 Immunity in Eczema
Th1, Th2, and Th17 are important arms of the immune system.
Inflammation and increased permeability of the skin barrier in people with eczema are fueled by the Th2 immune response. That’s why new eczema drugs target IL-4 and IL-13, the main cytokines that flood the body when Th2 is overly active. This arm of your immune system is tied to allergies and infections (Sodre et al., 2022; Cukrowska et al., 2021).
Th2 tends to oppose Th1, which is usually seen as beneficial. When people talk about “immune boosting,” they are actually referring to increasing Th1. Yet, Th1 has a dark side—its activation seems to underlie eczema flareups in some cases (Brunner et al., 2018).
Lastly, Th17 gets activated on the skin in other eczema cases. This adds to excessive skin permeability and damage (Wacleche et al., 2017; Sugaya, 2020).
Therefore, the aim is not just to “boost your immune system”—it’s to balance it. Not all eczema patients are the same, so probiotic supplementation should be individualized.
Although all eczema patients would likely benefit from targeting Th2 overactivity, some may also require Th1 and Th17 lowering action. Others may tolerate boosting Th1 (Brunner et al., 2018).
In a recent animal study, a probiotic strain isolated from the feces of healthy Koreans (Lactobacillus paracasei KBL382) improved eczema symptoms by balancing the gut microbiome and lowering Th1, Th2, and Th17 cytokines (Kim et al., 2020).
Another probiotic strain isolated from kimchi (Lactobacillus sakei WIKIM30) lowered Th2 inflammation and balanced the gut microbiome (Kwon et al., 2018).
In contrast, Lactobacillus casei and Lactobacillus paracasei increased the Th1 response in blood cells from children with eczema (Gorska et al., 2016).
Clinical studies need to test how these strains might affect immunity and eczema symptoms to determine the net effect.
Summary
Eating more probiotic-rich foods or taking a probiotic supplement may have a positive effect on eczema flares by introducing “good” bacteria (Sodre et al., 2022).
However, it’s not enough to just take any probiotic. When it comes to eczema—strain specificity, timing, and dosage matter a lot.
Best Probiotics for Eczema in Adults
Research Overview
According to a 2022 meta-analysis of seven human studies, probiotics showed a potential to relieve the symptoms of eczema in adults compared to the placebo. However, their effectiveness varied according to the strain, period, and form of administration (Sodre et al., 2022).
“Most of the studies in this present review described effective and beneficial results with probiotic treatments,” the authors conclude.
The following probiotics were researched in clinical trials of adults with eczema (Sodre et al., 2022, Drago et al., 2011, Drago et al. 2012)
- Lactobacillus salivarius LS01 over 4 months (lowers Th1)
- Lactobacillus fermentum ME-3 for 12 weeks
- Lactobacillus paracasei K71 for 12 weeks
- Streptococcus thermophilus enriched with probiotic cultures L. paracasei Lpc-37, L. acidophilus 74–2 and B. lactis DGCC 420 for 8 weeks
Mixed-strain probiotics best reduced eczema symptoms, followed by single Lactobacillus species. Bifdobacterium species alone seemed to worsen eczema. The added benefits of mixed-strain probiotics may be due to synergistic effects on the gut microbiome and immune system (Jiang et al., 2020).
Despite promising findings, further clinical trials are needed.
To add, low vitamin D levels increase the risk of eczema and make existing eczema more severe; children are at special risk.
The strain L. reuteri NCIMB 30242 has been clinically researched for boosting vitamin D levels. Analyses show that increasing vitamin D levels may help with eczema. Further clinical trials should test this strain in eczema patients with vitamin D deficiency (Hattangdi-Haridas et al., 2019).
Unfortunately, various probiotic products touted for eczema relief on the market lack human studies. Some strains that have not been clinically researched and are backed only by studies in animals or cells include Lactobacillus paracasei LOCK 0919, Lactobacillus casei LOCK 0908, and Lactobacillus casei LOCK 0900 (Gorska et al., 2016).
How Long Does it Take to See the Results?
Most studies on eczema patients suggest that probiotics need to be taken for at least 8 weeks. In some studies, people took probiotics for over 6 months (Jiang et al., 2020).
Best Probiotics for Eczema in Children
The following probiotics have shown positive results in clinical trials of children and adolescents with eczema (Jiang et al., 2020; Vicente Navarro-López et al., 2018; Cukrowska et al., 2021):
- Lactobacillus fermentum
- Lactobacillus plantarum CJLP133 P
- Lactobacillus rhamnosus (MP108)
- Bifidobacterium lactis CECT 8145, Bifidobacterium longum CECT 7347, and Lactobacillus casei CECT 9104
- Bifidobacterium bifdum, Lactobacillus acidophilus, Lactobacillus casei, and Lactobacillus salivarius
- Lactobacillus rhamnosus ŁOCK 0900, Lactobacillus rhamnosus ŁOCK 0908, and Lactobacillus casei ŁOCK 0918 (specifically for children under 2 years old with atopic dermatitis and cow’s milk protein allergy)
Recent analyses reveal that probiotics may help prevent or relieve eczema only in children over one year (Jiang et al., 2020).
More research is needed before any of these strains they can be safely recommended.
Best Probiotics for Prenatal Eczema Prevention
The majority of research on probiotics for eczema tried to uncover whether supplementation during pregnancy and early infancy may stop the disease from developing in its tracks.
According to a 2020 meta-analysis, probiotics may lower the incidence of eczema in babies only if the mother took them while pregnant. Probiotics can then continue to be given to the baby after birth. Interestingly, only giving probiotics to babies after birth did not prevent eczema (Jiang et al., 2020).
The following probiotic strains have been clinically researched for helping prevent eczema prenatally (Jiang et al., 2020, Dotterud et al., 2010; Tan Lim et al., 2021; Singer et al., 2018):
- Lactobacillus rhamnosus HN001
- Lactobacillus rhamnosus LGG
- Bifidobacterium animalis subsp. lactis BB-12
- Lactobacillus acidophilus
- Lactobacillus paracasei ssp paracasei F19
- Bifidobacterium breve M-16V
- Bifdobacterium bifdum BGN4 and Bifdobacterium lactis AD011
- Lactobacillus salivarius CUL61, Lactobacillus paracasei CUL08, B. animalis subsp. lactis CUL34, and B. bifdum CUL20
- Lactobacillus paracasei ST11 and Bifidobacterium longum BL999
- Lactococcus lactis W58, Bifidobacterium lactis W52, and Bifidobacterium bifidum W23
Due to variable strains, dosages, and populations, additional trials are warranted.
The Bottom Line
Certain probiotics may help with eczema by rebalancing the gut and skin microbiome.
Some of the more well-known probiotic strains studied in patients with eczema include Lactobacillus rhamnosus, Lactobacillus paracasei, Lactobacillus acidophilus, Bifidobacterium lactis, and Bifidobacterium animalis.
Mixed-strain probiotics seem to have the greatest effect, followed by single Lactobacillus species, while certain Bifidobacterium species alone might worsen eczema.
More studies on specific age groups and eczema types are needed to individualize supplementation and determine the most beneficial strains and dosing regimens.
Consult your care provider if you have a weakened immune system, bowel condition, or other chronic diseases. Be sure to also consult your provider if you are pregnant, breastfeeding, or plan to give your child probiotics.
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Ana Aleksic, MSc (Pharmacy)
Ana is an integrative pharmacist and scientist with many years of medical writing, clinical research, and health advising experience. She loves communicating science and empowering people to achieve their optimal health. Ana has edited 800+ and written 200+ posts, some of which reached over 1 million people. Her specialties are natural remedies, drug-supplement interactions, women’s health, and mental health. She is also a birth doula and a strong advocate of bridging scientific knowledge with holistic medicine.
1 comment
My son is 24 a d has enzyma I believe due to his por diet. Which product do you suggest?