Intervention Review

Probiotics for treating eczema

  1. Robert John Boyle1,*,
  2. Fiona J Bath-Hextall2,
  3. Jo Leonardi-Bee3,
  4. Dedee F Murrell4,
  5. Mimi LK Tang5

Editorial Group: Cochrane Skin Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 27 APR 2008

DOI: 10.1002/14651858.CD006135.pub2


How to Cite

Boyle RJ, Bath-Hextall FJ, Leonardi-Bee J, Murrell DF, Tang MLK. Probiotics for treating eczema. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD006135. DOI: 10.1002/14651858.CD006135.pub2.

Author Information

  1. 1

    Royal Children's Hospital, Allergy and Clinical Immunology, Parkville, Victoria, Australia

  2. 2

    The University of Nottingham, School of Nursing, Faculty of Medicine and Health Science, Nottingham, UK

  3. 3

    The University of Nottingham, Division of Epidemiology and Public Health, Nottingham, UK

  4. 4

    St George Hospital, Department of Dermatology, Sydney, NSW, Australia

  5. 5

    Royal Children's Hospital, Immunology, Parkville, Victoria, Australia

*Robert John Boyle, Allergy and Clinical Immunology, Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia. r.boyle@pgrad.unimelb.edu.au. bob.boyle@rch.org.au.

Publication History

  1. Publication Status: New
  2. Published Online: 8 OCT 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Probiotics have been proposed as an effective treatment for eczema, and recently a number of clinical trials have been undertaken.

Objectives

To assess the effects of probiotics for the treatment of eczema

Search methods

We searched the Cochrane Skin Group Specialised Register (to April 2008), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2,2008) MEDLINE (from 2003 to April 2008), EMBASE (from 2005 to April 2008), PsycINFO, AMED and LILACS (from inception to April 2008) and ISI Web of Science (to December 2006) and reference lists of articles. We also searched registries of ongoing clinical trials, conference proceedings and searched for adverse events.

Selection criteria

Randomised controlled trials of live orally ingested microorganisms for the treatment of eczema.

Data collection and analysis

Two authors independently applied eligibility criteria, assessed the quality of trials and extracted data. We contacted study authors for more information where necessary. We recorded adverse events from the included studies, and from the separate adverse events search.

Main results

Twelve randomised controlled trials involving 781 participants met the inclusion criteria. All trial participants were children. There was no significant difference in participant or parent-rated symptom scores in favour of probiotic treatment (5 trials, 313 participants). Symptom severity on a scale from 0 to20 was 0.90 points lower after probiotic treatment than after placebo (95%CI -1.04, 2.84; p = 0.36).There was also no significant difference in participant or parent-rated overall eczema severity in favour of probiotic treatment (3 trials, 150 participants). There was no significant difference in investigator rated eczema severity between probiotic and placebo treatments (7 trials, 588 participants). On a scale from 0 to 102 investigator rated eczema severity was 2.46 points lower after probiotic treatment than after placebo treatment (95%CI -2.53, 7.45 p = 0.33). Significant heterogeneity was noted between the results of individual studies, which may be explained by the use of different probiotic strains. Subgroup analysis by age of participant, severity of eczema, presence of atopy or presence of food allergy did not identify a population with different treatment outcomes to the population as a whole. The adverse events search identified some case reports of infections and bowel ischaemia caused by probiotics.

Authors' conclusions

The evidence suggests that probiotics are not an effective treatment for eczema, and probiotic treatment carries a small risk of adverse events.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Probiotics for treating eczema

There is not enough evidence to recommend using probiotics for the treatment of eczema.

Eczema is a skin condition characterised by an itchy red rash, which affects between 5 and 20% of people at some time in their life. People with eczema have different bacteria in their gut to people without eczema, and sometimes they have inflammation in their gut. It may be possible to treat eczema symptoms by changing the mix of gut bacteria or by reducing inflammation in the gut. One type of treatment that might achieve this is probiotics - these are live micro-organisms taken by mouth such as the Lactobacillus bacteria found in unpasteurised milk and yoghurt. This review of twelve trials found that probiotics do not reduce eczema symptoms such as itching, nor do they change the overall severity of eczema judged by patients or their doctors. The results varied between different trials but overall do not suggest that probiotics are an effective treatment for eczema. Further studies of new probiotics are needed, because it is possible that different types of probiotics which haven't yet been studied in eczema treatment could be more effective. Probiotics can rarely cause infections and gut problems.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

使用益生菌來治療濕疹

益生菌 (Probiotics) 被推薦為一種有效治療濕疹的方法,近來有許多臨床試驗在進行中。

目標

為了評估益生菌在治療濕疹上的效果

搜尋策略

我們搜尋了以下的資料庫,包括: Cochrane Skin Group Specialised Register (至2008年四月止) ,the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2,2008) ,MEDLINE (自2003年至2008年四月) ,EMBASE (自2005年至2008年) ,PsycINFO, AMED and LILACS (自初刊到2008年四月) ,ISI Web of Science (至2006年十二月) ,以及這些文章中提及的參考文獻。我們還搜尋正在進行中的臨床試驗、相關會議以及不良反應紀錄。

選擇標準

以口服益生菌活菌來治療濕疹的隨機對照試驗

資料收集與分析

兩位作者分別獨立根據選定的標準,來評估各個試驗的品質並分析數據。有需要時,我們也聯繫研究作者以得到更多資訊。我們同時記錄了囊括在研究中的不良反應,及其他搜尋結果中發現的不良反應。

主要結論

總共12個隨機對照試驗符合遴選標準,包括781位受試者。所有的受試者皆為小孩子。其中有5個試驗,總共313個受試者的結果中顯示使用益生菌治療以後,以受試者或是父母親評量的症狀分數上 (participant or parentrated symptom scores) ,並沒有明顯的差異。使用最低0分最高20分的症狀評量標準來做評估,使用益生菌的組別相較於使用安慰劑的組別,症狀嚴重度僅僅下降了0.9分 (95% CI −1.04, 2.84; p = 0.36) 。 以受試者或是父母親評量的整體濕疹嚴重度 (participant or parentrated overall eczema severity) 來看,實驗組和對照組也沒有明顯的差異 (3個試驗,共150個受試者) 。以研究者本身評估的整體濕疹嚴重度 (investigator rated eczema severity) 來看,使用益生菌以及使用安慰劑做治療也沒有明顯的差異 (7個試驗,共588個受試者) 。用最低0分最高102分的症狀評量標準來做評估,使用益生菌的組別相較於使用安慰劑的組別,症狀嚴重度僅僅下降了2.46 (95% CI −2.53, 7.45 p = 0.33) 。 從一些個別的研究中可以發現顯著的不一樣的實驗結論,這或許和使用不同品種的益生菌有關。而從子族群分析中發現,受試者的年紀、濕疹的嚴重程度、有異位性體質或是對食物過敏等,與其他一般的人比較,在治療的結果上並不會有明顯的不同。從益生菌不良反應的搜尋中,發現一些病例報告 (case reports) 指出,益生菌可能引起感染或是腸胃道缺血。

作者結論

這些證據顯示益生菌並非有效治療濕疹的方法,而且有引起不良反應的風險。

翻譯人

本摘要由馬偕醫院黃心穎翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

益生菌在溼疹治療的角色: 沒有足夠的證據讓我們推薦使用益生菌來治療濕疹。濕疹的特色是一種會癢的紅疹皮膚病,約有5% −20% 的人在一生中曾有濕疹。罹患濕疹的人相較於一般人,在腸道中有著不一樣的細菌,有時會有腸道發炎的現象。藉由改變腸道中的菌叢以及改善腸道發炎的反應,或許可以治療濕疹症狀,而使用益生菌就可能是一種方法,來幫助我們達到這個目的。益生菌是需要經由口服的活菌,例如從未經巴斯德消毒法的牛奶中或是優格中萃取出的乳酸桿菌。這篇涵蓋12篇試驗的回顧性文章,發現益生菌的使用不會減緩濕疹引起的皮膚癢等臨床症狀,也不會改善經由病患本身或是醫師評估的濕疹嚴重程度。不同的臨床試驗有不同的結果,但整體而言都不推薦益生菌作為有效治療濕疹的方法。未來仍有必要進一步研究新的益生菌,因為這些尚未在溼疹治療上被研究的不同種類的益生菌,可能會有更好的臨床療效。此外,益生菌偶爾會造成感染或是腸胃道的問題。