Improving AD: Adding Lactobacillus GG boosts treatments

September 1, 2008

A small prospective study suggests oral Lactobacillus could be helpful for patients with atopic dermatitis, although the study's results require validation, a study co-author says.

Key Points

Previous reports from Europe suggest probiotics could be helpful in ameliorating some symptoms of eczema, says Sharon A. Glick, M.D., director of pediatric dermatology, SUNY-Downstate and Kings County Hospital Center, Brooklyn, N.Y.

Study challenges

Similarly, Dr. Glick says, "I had had multiple patients with severe AD. And anecdotally, they seemed to get better when I added Lactobacillus."

To analyze the treatment more formally, Dr. Glick and colleagues performed a prospective, double-blinded, placebo-controlled study to assess the effect of adjunctive LGG on SCORAD scores on patients with AD.

Rather than focusing on children with high IgE levels exclusively, she says, "We measured the IgE levels in all patients that agreed to participate in our study, and considered IgE as one of the variables."

However, enrolling patients proved very challenging, Dr. Glick says. Even though researchers explained to parents that study participants would get the same conventional treatments whether or not they got LGG, very few would allow their children to participate, Dr. Glick tells Dermatology Times.

Generally, parents are reluctant to enroll children in research studies, she says.

Study parameters

Ultimately, researchers enrolled 17 subjects, ranging in age from 6 months to 8 years, with moderate-to-severe AD.

Researchers randomized these children to receive either placebo or 10 billion to 20 billion colony-forming units (CFU) daily for nine to 12 weeks.

Because dosing depended on each patient's weight, investigators gave children weighing under 12 kg one capsule (10 billion CFU) daily. Children weighing more than 12 kg got one capsule twice daily.

At patients' initial visits and at weeks three, six and 12, researchers examined patients and administered the SCORAD index, which factors in the extent and severity of skin erythema, edema/papulation, oozing/crusting, excoriation, lichenification and dryness. Researchers drew IgE levels from all participants at the study's beginning and end.

Unfortunately, researchers lost eight patients to follow-up, Dr. Glick says. "Because our numbers are so small, I don't believe we can generalize from our study's conclusions," although its results suggest LGG merits further research, she says.

Results

More specifically, both the LGG group and the placebo group achieved improvements in SCORAD scores. In the LGG group, mean SCORAD dropped from 73.10 initially to 23.07, versus a decline from 58.58 to 24.67 in the placebo group.

Perhaps more importantly, the average slope of the decrease in SCORAD over the study's first three weeks was -33.22 for patients receiving LGG, versus -10.25 for those who received placebo (p=0.057).

Similar patterns emerged between baseline and week 6 (-24.14/LGG versus -13.24/placebo) and from baseline to the study's end, although neither of these results reached statistical significance.

Seven of the nine patients who completed the study presented with elevated IgE at baseline. Among these seven, those receiving LGG averaged a 52 percent decrease in IgE levels.

Conversely, patients with high IgE levels who received placebo averaged a 23 percent decrease in IgE. All patients tolerated treatment well, Dr. Glick says.

Conclusion

"Our main conclusion was that SCORAD scores in the Lactobacillus group decreased at a much greater slope. In other words, their symptoms got better quicker than those of placebo patients did," Dr. Glick says.

While these results are encouraging, she says, they'll need validation with a larger study.

Disclosure: Dr. Glick reports no relevant financial interests.

For more information:

http://www.aad.org/