Articles

Evidence based

Evidence Based

This article is based on scientific evidence, written by experts and fact checked by experts.

Our team of licensed nutritionists and dietitians strive to be objective, unbiased, honest and to present both sides of the argument.

This article contains scientific references. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.

Using Probiotics for Eczema Relief: Your Guide

Written by Dr. Michael Ruscio, DC on December 20, 2022

Written by Dr. Michael Ruscio, DC on December 20, 2022 — Reviewed by Heidi Turner

• What is Eczema?|
• The Gut-Eczema Connection|
• How Probiotics Can Help|
• Are Specific Probiotics Needed?|
• Two-Step Eczema Healing Plan|
• The Bottom Line|

Eczema is the most common, chronic inflammatory skin condition worldwide and its prevalence is on the rise. In fact, eczema cases have increased two to three-fold in western countries just over the past decade [1]. 

Conventional dermatology treatments like creams, moisturizers, emollients, and oral or topical steroids may provide some relief for your itchy, burning skin. However, they can be messy, don’t address the cause of eczema, and are associated with potentially serious side effects.

Research shows that probiotics, especially those containing multiple strains, are effective for both preventing and treating eczema. They also hold an advantage over conventional treatments as they are safe and target the root cause(s) of eczema including poor gut health and food sensitivities. 

Probiotics for eczema can be used to both treat and prevent symptoms. Most cases of eczema start in childhood and giving probiotics to expectant mothers and infants right after birth can significantly reduce eczema risk. For adults and kids who already have eczema, probiotics can help curb your symptoms. 

In this article, I’ll share the background on eczema and what the research says about using probiotics for eczema prevention and treatment. I’ll also walk you through my two-step eczema healing process and how probiotic supplements fit into the eczema equation. 

What is Eczema?

Eczema (also called atopic dermatitis) is a chronic, inflammatory skin condition that affects 10 to 30% of children and 2 to 10% of adults in developed countries [2]. It’s characterized by persistent itching, redness, rashes, and thickened or leathery skin [2, 3]. Eczema is associated with other allergic diseases like [2, 3]:

• Food allergies
• Allergic rhinitis
• Asthma

Eczema can be divided into two categories [4, 5]:

1. Atopic eczema (most common): characterized by the presence of IgE antibodies (proteins used by the immune system) that react to either food or inhalant allergens and provoke an allergic response.
2. Non-atopic eczema: characterized by low levels of total IgE antibodies, negative skin prick tests, and undetectable levels of specific IgE antibodies to allergens like pollen or foods.

Sixty percent of eczema cases occur within the first year of life [3], but you can develop eczema at any time. Let’s look at what we know about the causes of eczema. 

What Causes Eczema?

There’s no one identified cause of eczema, rather it likely results from a combination of genetics, environmental factors, and microbial imbalances in the gut and on the skin. 

One literature review noted that reduced consumption of fermented foods, repeated antibiotic use, and decreased microbial exposure (perhaps from less interaction with soil and/or the widespread use of hand sanitizers and cleaners that kill bacteria) can negatively impact the gut microbiome and predispose people to eczema [6]. 

Additional considerations in the development of eczema are C-section births and the use of formula over breastfeeding. These decisions are often out of the mother’s control and can be medically necessary but still pose a risk. [6]. People with eczema have been found to have:

• Skin barrier defects that increase their susceptibility to environmental irritants and other allergens [2, 3].
• Dry skin that allows water to escape leading to dehydrated skin [3].
• A skewed inflammatory immune response [3].
• Genetic variations that impact skin cell maturity, which can result in a “leaky” skin barrier [3].
• Reduced numbers of beta-defensins (proteins that help fight off bacteria, viruses, and  fungi) [3].
• Microbial imbalance at multiple skin sites and greater presence of pathogenic bacteria (Staphylococcus aureus) [7].
• Gut dysbiosis and reduced gut microbiome diversity [8, 9].  

While it’s not yet fully understood, research suggests food intolerances or sensitivities and poor gut health may be to blame for eczema and other inflammatory skin conditions [8, 9, 10, 11]. Let’s take a closer look at the gut-eczema connection before we get into why you may want to consider probiotics for eczema prevention and treatment.

The Gut-Eczema Connection

Not all clinical trials confirm gut microbiome alteration in those with eczema [12], but the overall trend in the literature suggests that gut bacteria imbalances do contribute to eczema development. 

One review found reduced gut microbiome diversity in eczema patients [9] and another found infants with eczema to have lower levels of healthy microbes and higher levels of pathogenic bacteria in the gut [8]. While these findings are only associated with atopic dermatitis, having a gastrointestinal condition that has a proven link to dysbiosis, like irritable bowel syndrome (IBS), significantly increases your risk of eczema [10].

There’s also some evidence to suggest that eczema may actually be an autoimmune condition where antibodies attack normal body tissues [13]. This matters because leaky gut, a common feature in autoimmunity, has also been tied to the development of eczema [14, 15].

Leaky gut occurs when the intestinal lining becomes damaged and allows bacterial metabolites and food particles to leak into the bloodstream. When the immune system encounters these misplaced metabolites and food, it may treat them as a threat. This immune response can have a downstream effect of attacking your own cells, in the case of eczema, the skin cells. 

When we use treatments that target leaky gut and overall gut microbiome balance, we can heal eczema through the gut-skin axis instead of just suppressing its symptoms through corticosteroids and moisturizers. 

Probiotics have the ability to modulate the gut microbiome, so they’re a promising therapy when it comes to eczema prevention and treatment. Let’s look at how probiotics exert their effects on eczema.

How Do Probiotics Help Eczema?

Probiotics are bacterial species of microorganisms that provide benefit to the host. As I discuss in Healthy Gut, Healthy You, probiotics rebalance the gut microbiome and help to increase the diversity and amount of good microbiota you have.  

When it comes to eczema, probiotics appear to work by modulating the immune system [16, 17, 18]:

• Probiotics calm the immune cells that are overactive in eczema.
• Probiotics increase the activity of immune cells that promote a balanced immune system and response.

In addition, probiotics may improve eczema by [16]:

• Reducing systemic (body-wide) inflammation.
• Improving gut barrier function [18].
• Decreasing pathogen adherence and invasion in the gut.
• Degrading food antigens (proteins that act as a potential threat to your immune system).

Let’s check out what the research tells us about the use of probiotics for the treatment of atopic dermatitis. 

Probiotics For Eczema: Treatment

Current research shows that probiotics improve eczema in adults and children. One systematic review and meta-analysis found probiotics led to significant clinical improvement and better quality of life in adults with eczema [16]. However, this same clinical study found no improvement in skin and itch severity, or immune response when compared to placebo.

Other studies in adults with eczema have found different probiotics to lead to:

• Moderate reductions in the severity of eczema in the short term [19]
• Large improvements in long-term quality of life [19]
• Reduced eczema symptoms, itching, and improved clinical outcomes [20]

In kids with eczema, a placebo-controlled trial of probiotics for eight weeks showed significant improvement in clinical outcomes and quality of life [21]. And three months of probiotics significantly improved eczema symptoms [22].

While the research is mixed on the use of probiotics for eczema, there is ample evidence of using these beneficial bacteria for unhealthy skin and any underlying factors like a leaky gut or dysbiosis. Additionally, probiotics are relatively inexpensive, safe, and have virtually no side effects making them a great option. If nothing else has seemed to help your itchy skin so far, you may want to give these microbes a shot.

Let’s review the evidence for the use of probiotics for eczema prevention.

Probiotics For Eczema: Prevention

Like probiotics for eczema treatment, research on their use in eczema prevention is mixed. But overall, it suggests that probiotics given to pregnant mothers and infants in the months right after birth can reduce the risk of developing eczema, even in kids at high-risk (those with a family history of allergic diseases) [23]. 

Four different systematic reviews and meta-analyses found probiotics to reduce the risk of developing eczema [23, 24, 25, 26]. And it seems that giving probiotics to mothers during pregnancy or giving them to both mom and baby leads to the best result for lowering eczema risk [23, 25].

My clinical experience shows that the prevention of eczema with probiotics doesn’t only apply to infants and kids, though. Since gut microbiome imbalances and leaky gut may contribute to eczema and we know probiotics can improve gut and immune system function, it makes sense that probiotics may be helpful for preventing eczema in adults too.

Randomized controlled trials seem to suggest that probiotics for eczema treatment can be beneficial but do you need a specific type of probiotic for the best results? 

Are There Specific Probiotics for Eczema?

It seems that all of the research trials on probiotics for eczema have involved what I call category 1 probiotics, which are essentially a Lactobacillus/Bifidobacterium blend [16, 24, 27]. 

A systematic review and meta-analysis found a Lactobacillus/Bifidobacterium blend to have the highest effectiveness for improving disease severity in the short term and quality of life in the long term [19]. In addition, low-quality evidence suggests that using these strains in pregnant women and infants can reduce eczema risk [24].  

To sum things up, it’s probably not necessary to be highly specific about which strain you use for eczema [28]. Numerous different strains of Lactobacillus and Bifidobacterium have been found to be effective in treating eczema in children [28]. And while there doesn’t appear to be any studies specifically using category 2 (Saccharomyces boulardii) and category 3 (soil-based) probiotics just yet, the evidence supports the use of multistrain probiotics [23], so combining all three categories is a safe bet for eczema. 

At the Ruscio Institute for Functional Medicine, I advocate for a multi-strain approach and often use all three probiotic categories in combination as I’ve found this to be extremely effective for improving gut health, which can then lead to improvement in skin health.

What About Topical Probiotics for Eczema?

Topical probiotics that are applied to the skin have also been studied (mostly in adults) but more research is needed to confirm their effectiveness. One systematic review found patients experienced improved eczema symptoms and severity, but said definitive conclusions couldn’t be made about their use just yet [29]. 

While topical probiotics are likely safe, they don’t have as strong of evidence backing them as oral probiotics for eczema. It’s probably best to start with oral probiotics first and move on to topical formulas if you don’t get symptom relief. 

While probiotics appear to be promising for both preventing and treating eczema, you’ll probably experience more benefit by making some diet and lifestyle changes as well. Let’s review a two-step guide for healing eczema.

Two-Step Eczema Healing Plan

If you already have eczema, you’ll probably experience more complete healing by implementing a comprehensive nutrition and lifestyle plan that includes probiotics. Here’s a guide to get you started:

Step One: Reset Your Diet and Lifestyle

Resetting your diet and lifestyle are really the foundation of healthy skin. I like to start with a short-term liquid fast (2–4 days) with Elemental Heal and then transition to a Paleo diet.

The Paleo diet focuses on whole foods and cuts out foods that may cause inflammation like dairy products, grains, beans, legumes, unhealthy fats (like corn, soybean, and peanut oils), and artificial sweeteners. On this meal plan, you’ll be enjoying:

• Fresh vegetables and fruits
• Fresh meats, fish, and eggs
• Healthy fats and oils (avocado, coconut, olive)
• Nuts
• Seeds

You may do extremely well on the Paleo plan, but if your symptoms aren’t improving after a few weeks, you may need to move on to a more targeted option like the low FODMAP diet. 

As far as lifestyle goes, here are some tips to consider:

• Spending time in the sun and in nature
• Exercising an appropriate amount
• Taking a short walk or stretch every hour during the day
• Getting seven to nine hours of quality sleep every night
• Practicing a daily stress management technique like meditation
• Nurturing healthy relationships and social connections
• Avoid hot water when you shower to prevent further drying your skin

If you change up your diet and lifestyle and your eczema symptoms have disappeared, then that’s great. You can begin to reintroduce some of the eliminated foods one at a time and monitor for the return of your eczema symptoms. 

If no symptoms return, you can continue with your healthy lifestyle and keep track of your progress. But, if you’ve had some success yet still have nagging eczema symptoms, or if you reintroduce some of the eliminated foods and your symptoms return, move on to step two (if you haven’t already).

Step Two: Support Your Gut with Probiotics

My probiotic protocol includes all three categories of probiotics. You may want to start with the Lacto-Bifido Probiotic Blend and if you tolerate this well, add the category 2 probiotic, Saccharomyces boulardii (a probiotic yeast), and then category 3, the Soil-Based Probiotic.

We’ve gone into detail on probiotics for eczema, but they have many health benefits for a wide array of conditions. You may experience improvements in your eczema symptoms but also notice that you have less bloating, clearer thinking, improved stool consistency, improved mood, better sleep, and less joint pain.

If you work through diet, lifestyle, and probiotics for a few weeks and aren’t seeing the benefits you desire, you may need a more personalized plan. The Great-in-8 Action Plan I detail in Healthy Gut, Healthy You provides a step-by-step guide for healing your gut, which will likely lead to significant improvement in eczema symptoms as well.  

Diet, Lifestyle, and Probiotics For Eczema Healing

Eczema is a chronic, inflammatory skin condition that can significantly affect your quality of life. Traditional treatments can be messy and come with adverse effects. Probiotics are a treatment option that’s safe, effective, and generally well-tolerated. 

Probiotics have been found to both prevent and treat eczema by modulating the immune response and improving gut health. Giving probiotics to mothers during pregnancy or giving 

them to both mom and baby seems to provide the best protection from eczema. For kids and adults who already have eczema, probiotics can significantly reduce eczema symptoms and improve quality of life. 

Multi-strain probiotics are most effective, so it’s probably not necessary to be highly specific about which probiotic strain you use for eczema. In addition, making dietary and lifestyle-related changes that improve gut health may enhance the effects of probiotics for eczema. 

If you’ve worked your way through the Great-in-8 Action Plan in Healthy Gut, Healthy You but still have eczema symptoms, please contact us at the Ruscio Institute for Functional Medicine for a more tailored plan.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.