Therapeutic Effects Elicited By The Probiotic Lacticaseibacillus Rhamnosus GG In Children With Atopic Dermatitis. The Results Of The Propad Trial

To evaluate therapeutic efficacy of a 12-week probiotic treatment, Lacticaseibacillus rhamnosus GG (LGG), in children with atopic dermatitis (AD).

The study enrolled 100 children aged 6 to 36 months with AD at a tertiary pediatric allergy center. Most patients had mild (40%) or moderate (53%) AD.

The study was a double-blind, placebo-controlled trial with participants randomized (1:1) into 5 groups: daily placebo capsule or daily capsule containing 1 × 10 10 CFU LGG. Caregivers received a diary to record (1) daily consumption of study product, (2) drugs and emollients used for AD, and (3) adverse events. Following enrollment, monthly clinical examinations were performed over 4 months, during which AD severity was assessed using the Scoring Atopic Dermatitis (SCORAD) index, quality-of-life of the preceding week was assessed through the Infant Dermatitis Quality of Life questionnaire, and participant diaries were reviewed. Gut and skin microbiomes were analyzed from fecal and skin samples.

Both groups demonstrated similar improvement in SCORAD index until week 4; thereafter, subjects receiving LGG exhibited a significant improvement in SCORAD index compared with placebo throughout the treatment period, with a sustained benefit observed at 4 weeks postintervention. There was an improvement in Infant Dermatitis Quality of Life scores and use of rescue topical corticosteroid in both groups; however, the degree of improvement was statistically higher in patients receiving LGG. When analyzing the gut and skin microbiome, participants receiving LGG demonstrated (1) increased fecal butyrate levels, (2) increased fecal abundance of butyrate-producing bacteria including Akkermansia, (3) increased skin abundance in Prevotella, Veillonella, and Ralstonia, and (4) decreased skin abundance of Stenotrophomonas and Microbacterium.

Once daily LGG for 12 weeks as adjunctive treatment of AD in children improved disease severity, quality of life, and rescue topical corticosteroid use substantially compared with placebo. Additionally, LGG supplementation demonstrated positive effects on the “gut-skin-axis” in patients with AD.

Multiple studies demonstrate that AD has a complex, multifactorial pathogenesis with dysbiosis in the “gut-skin-axis” as a potential contributor. This study provides evidence LGG may promote positive immunomodulation of the gut and skin microbiome and serve as a steroid-sparing tool to treat mild to moderate AD adjunctive to daily emollient use. Because of the finite study period of 16 weeks, limited number of patients with severe AD, and exclusion of comorbid atopic disease, data remains limited on the benefits of LGG with longer duration and in these populations respectively.