Probiotics for Atopic Dermatitis

Abstract

This chapter provides information regarding the chronic inflammatory skin disorder atopic dermatitis (AD), highlighting the prevalence of the disease, different diagnostic criteria, diagnosis procedures and clinical features of AD. The pathogenesis of AD is multifactorial resulting from complex interplay among immune dysregulation, epidermal barrier disruption, environment, and genetic predisposition, nutritional, psychological and pharmacological factors. Immune dysregulation and epidermal barrier dysfunction are the major pathophysiological defects along with genetic variation in Filaggrin (FLG), the most recurring finding contributing towards AD development. The major risk factors of AD are positive family history, environmental and lifestyle factors, use of broadspectrum antibiotics in pregnancy and infants especially S. aureus colonisation and superinfections. Sleep disturbance, ADHD, psychiatric disorders, asthma and allergic rhinitis are the co-morbidities associated with chronic skin disease. Though there is no cure for AD, management basically aims at improving symptoms by using therapeutic agents like emollients, calcineurin inhibitors, topical corticosteroids, systemic immunosuppressants and phototherapy depending upon the severity of the symptoms. Gut microbiome impacts AD through immunologic pathway, metabolite pathway and neuroendocrine pathway. Probiotics helps in improving the intestinal barrier by modulating the immune status and intestinal microbiome by performing immunomodulatory effect, metabolic effect and standardisation of microbial composition by protection of the mucosal surface against pathogens. This chapter also explores information regarding various studies linking gut and skin microbiome with AD and also summarises the clinical trials using probiotics as interventions in improving the disease condition.