Probiotics for pediatric atopic dermatitis: A systematic review and meta-analysis of randomized controlled trials

Abstract

Background

Atopic dermatitis is a prevalent chronic inflammatory skin disease in children and the severity of the disease can be affected by modulation of gut microbiota through probiotics. Nonetheless, the clinical trial outcomes on the effectiveness of probiotics in child atopic dermatitis are inconclusive.

Objective

We sought to compare the effects of using probiotics in comparison with placebo in children/adolescents with eczema/atopic dermatitis.

Methods

We searched PubMed/MEDLINE, Google Scholar, and Cochrane Library from inception to March 2025. Statistical analyses were done in Review Manager version 5.4.1 (The Nordic Cochrane Centre, Copenhagen, Denmark). Pooling the trials using a fixed effect yielded standard mean difference (SMD) with 95% CI.

Results

A total of 13 randomized controlled trials were used. SCORing Atopic Dermatitis (SCORAD) was used for assessing the efficacy of probiotics on atopic dermatitis. Subgroup analysis demonstrated a statistically nonsignificant difference in SCORAD within the first 2 months of the treatment (SMD, −0.04 [95% CI, −0.24 to 0.16]; P = .71; I² = 52%), whereas a statistically significant decrease in SCORAD was found in probiotics (SMD, −0.20 [95% CI, −0.36 to −0.03]; P = .02; I² = 77%) after 2 months. Overall, analysis indicated that probiotics decreased SCORAD values significantly (SMD, −0.13 [95% CI, −0.26 to −0.01]; P = .04; I² = 69%). Qualitative analysis showed that probiotics provide better quality of life and improve clinical and anatomical outcomes than placebo.

Conclusions

Analysis found that probiotics can improve patient-reported quality of life in the short-term but not clinical results. However, SCORAD varies considerably over time and paucity of long-term follow-up data makes it difficult to determine the long-term clinical value of probiotics.

Atopic dermatitis (AD), also known as eczema, is a chronic, recurring inflammatory skin condition characterized by pruritus and eczematous lesions.¹ It often develops in early childhood in association with other atopic disorders such as asthma. AD affects up to 20% of children worldwide, and more than 60% of AD cases occur alongside asthma.² The etiology of AD involves a complex interplay between genetic predisposition, immune system dysregulation, epidermal barrier break, and environmental factors. Genetic mutations of the filaggrin gene, a key component of the skin’s barrier function, and immune dysregulation characterized by a surge of T_H2 cytokine activity result in chronic inflammation.³ Symptoms may include intense itching, erythema, rash, and lichenification of flexor surfaces of elbows, knees, face, and hand.⁴ Early diagnosis is crucial, on the basis of patient history, clinical morphology, and distribution of lesions, after the exclusion of other dermatologic conditions.¹ The standard management of AD is aimed at reducing the severity of symptoms, preventing exacerbations, and improving quality of life. Treatment includes regular use of emollients, moisturizers, topical corticosteroids, antihistamines, immunosuppressants, and phototherapy.⁵

Probiotics are microorganisms that provide health benefits when used as an adjunctive treatment for AD.⁶ Specific probiotic strains, such as Lactobacillus rhamnosus and Bifidobacterium lactis, may decrease the incidence of atopic lesions, including asthma, and reduce the severity of symptoms.⁷ Typical dosages for adults range from 10 billion to 20 billion colony-forming units per day, and for children, 5 billion to 10 billion colony-forming units per day.⁸ Probiotics, such as L rhamnosus, increase epithelial barrier integrity by upregulating tight junctions to reduce intestinal permeability and also lower microbial translocation.⁹ They promote anti-inflammatory cytokines such as IL-10 to enhance regulatory T-cell activity and mitigate inflammation.¹⁰ Probiotics reduce altered gut and skin microbial diversity and overgrowth of pathogenic organisms such as Staphylococcus aureus. Instead, they regulate gut microbiota balance by increasing beneficial bacteria such as the Lactobacillus and Bifidobacterium species.¹¹

To assess the effects of probiotics on AD in children, Huang et al¹² conducted a systematic review and meta-analysis of 13 randomized controlled trials (RCTs). The SCORing Atopic Dermatitis (SCORAD) tool was used to assess the severity of AD. Probiotics showed significantly higher SCORAD values over controls. In children 1 to 18 years old, probiotics were reported to have better efficacy at −4.50. Some strains of probiotics, such as L fermentum, L salivarius, and mixed strains, showed significant improvement in SCORAD values.¹² Meanwhile, several meta-analyses were performed. For instance, Jiang et al¹³ performed a meta-analysis to evaluate the effect of probiotics on the prevention and treatment of AD in children, finding that only mixed strains of probiotics significantly lowered the incidence and SCORAD values of AD. The literature highlights the significance of probiotics in the primary prevention of AD; however, the findings are limited by considerable heterogeneity, variability in the methodology, demographic characteristics of the participants, and routes of administration. Consequently, the role of probiotics in the treatment of AD remains inconclusive. Therefore, we aim to update the present literature to evaluate the clinical efficacy of probiotics in managing AD in children compared with the disease populations receiving placebo on the basis of evidence from RCTs.

Methods

Search strategy and databases

This systematic review and meta-analysis got registered and approved in PROSPERO (CRD42024615326). It was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).¹⁴ An electronic search was done using PubMed/MEDLINE from inception to March 2, 2025. The following search string was used: (atopic dermatitis OR eczema OR allergy∗ OR hypersensitivity∗) AND (probiotic OR probiotics OR “probiotic therapy” OR “probiotic supplement”) AND (child∗ OR adolescent∗ OR paed∗ OR pediatric∗ OR infant∗ OR neonates∗). We additionally searched the referenced articles of previously published meta-analyses, cohort studies, and review articles to identify any relevant studies.

Inclusion and exclusion criteria

Our inclusion criteria followed the Population, Intervention, Control, Outcomes, Study framework. The population included children and adolescents with any form of eczema or AD. The intervention consisted of any probiotics, and the control was a placebo. The primary outcome was to compare the effects of probiotics with placebo in children and adolescents with eczema or AD. Finally, the study designs included observational studies and RCTs. Exclusion criteria were based on initially reading the title and abstract that demonstrated parameters that did not relate to our Population, Intervention, Control, Outcomes framework. We had not considered any animal-based study, case report, case series, or cross-sectional study. Review articles were also excluded such as narrative reviews, systematic reviews, and meta-analyses. An important thing to note is that our topic focused on outcomes on a population already diagnosed and then treated with probiotics, and so we also excluded studies that showed only prevalence of eczema/dermatitis. In addition, we excluded studies that failed to provide a control group.

Data extraction and quality assessment

Two reviewers screened the electronic databases. Studies were exported to EndNote Reference Library version 20.0.1 (Clarivate Analytics, London, United Kingdom) and duplicate articles were screened and removed. Two investigators entered the data extracted from the selected studies on a computer spreadsheet. This helped to prevent any bias, and more precision was seen in the work. If there were discrepancies in the study, then they were resolved by mutual agreement.

Seven domains were assessed by the Cochrane Collaboration tool: adequate sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective outcome reporting, and free of other bias. The individual domains and overall risk-of-bias judgment were expressed on 1 of 3 levels: high risk of bias, unclear risk of bias, and low risk of bias. On the basis of these factors, the overall quality of evidence was deemed as high, moderate, or low risk of bias.

Statistical analysis

Review Manager version 5.4.1 (The Nordic Cochrane Centre [The Cochrane Collaboration, 2020], Copenhagen, Denmark) was used for all statistical analyses. The data from studies were pooled using the fixed-effects model. Analysis of results was done by calculating the standard mean difference (SMD) with their respective 95% CI. The chi-square test was performed to assess any differences between the subgroups. Sensitivity analysis was done to see whether any individual study was driving the results and to explore reasons for high heterogeneity. As per the Cochrane Handbook, the scale for heterogeneity (I²) was considered as follows: 25% to 60%, moderate; 50% to 90%, substantial; and 75% to 100%, considerable heterogeneity. A P value less than .1 indicated significant heterogeneity,¹⁵ and a P value less than .05 was considered significant for all analyses. Sensitivity analysis was done to assess whether any study was creating any bias in the study, and the funnel plot was generated in Revman to evaluate and assess any publication bias. Those factors that could not have been quantitatively assessed were analyzed qualitatively. A narrative approach was used in this case. This method was used to incorporate as many outcomes as possible, to provide a comprehensive study, and to evaluate those outcomes as well wherein analysis was not possible but seemed important for our study.

Results

Literature search results

Initially, 2540 articles were retrieved from PubMed/MEDLINE (1691), Google Scholar (200), and Cochrane Library (649). A total of 1975 articles were left after removing duplications, and 1845 articles were excluded on the basis of abstract and title, leaving 130 articles for full-text reading. We finalized 13 articles for our study. Fig 1 shows the PRISMA flowchart.

Fig 1.

PRISMA flow diagram.

Study characteristics

A total of 13 RCTs were included in our study with a patient population of 1133 children/adolescents.16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28 The demographic details of the finalized studies are provided in Table I. Among the studies, the largest was the one by Viljanen et al¹⁸ with 230 participants, and the smallest was the one by Isolauri et al²³ with 27 participants. The mean sample size per study was 87 participants. The percentage of female participants ranged from 32.3% to 54.9%, with some studies not reporting sex distribution. The mean age of participants varied from the youngest group in the study by Cukrowska et al²⁷ (8.5 months) to the oldest group in the study by Passeron et al²⁰ (5.85 years). Our studies were included from 10 different countries, reflecting a diverse geographic representation: Finland, the Netherlands, Poland, Germany, France, United Kingdom, and Sweden (Europe), South Korea (Asia), Australia, and New Zealand. Most of the studies used established criteria for the diagnosis of AD, such as Hanifin and Rajka, Hanifin, or Williams criteria. Most of the patients were found with mild to moderate severity of AD, although severe cases of AD were also treated with probiotics, details of which are provided in Table I. The most commonly studied probiotic strains were as follows: 5 studies studied L rhamnosus,^{19,22,25,27,28} 2 studied L fermentum,^17,24 2 studied B lactis,^23,26 1 studied L casei,²⁷ 1 studied L pentosus,¹⁶ and 1 studied L paracasei.²⁶ Some studies used multistrain combinations, such as L paracasei + B lactis,²⁶ L rhamnosus + L casei,²⁷ L rhamnosus + B lactis,¹⁹ and L rhamnosus GG with mixed probiotics.¹⁸ Complications after the treatment were found minimal, with several studies reporting no complications, whereas others reported gastrointestinal symptoms, including changes in the stool consistency, green loose stools, colic, vomiting, and mild abdominal pain (Table I).

Table I.

Demographic characteristics extracted from the included studies

Reference	Country	Study design	Diagnosis of AD	Severity of AD	Intervention used	Total population (n)	Female (%)	Mean age	Qualitative or quantitative analysis	Complications after treatment	Net risk of bias
Ahn et al16	South Korea	RCT	Diagnostic criteria developed by Hanifin and Rajka	Mild to moderate	L pentosus	82	54.9	5.1 y	Both	NA	Low
Brouwer et al28	The Netherlands	RCT	Hanifin criteria	Mild	L rhamnosus and L rhamnosus GG	50	NA	NA	Quantitative	NA	Low
Cukrowska et al27	Poland	RCT	Hanifin and Rajka criteria	Moderate	L rhamnosus and L casei	134	36.6	8.5 mo	Both	Changes in stool consistency	Low
Grüber et al25	Germany	RCT	Standard criteria	Mild to moderate	L rhamnosus GG	102	32.3	7.3 mo	Qualitative	Lower respiratory tract infection	Low
Gore et al26	United Kingdom, New Zealand, and Sweden	RCT	NA	Mild to moderate	L paracasei and B lactis	208	42	19 wk	Qualitative	Green loose stools, increased vomiting, colic, or feed refusal	Low
Holst et al22	Germany	RCT	Hanifin and Rajka criteria for infantile AD	Moderate	L rhamnosus GG	53	35.8	NA	Both	No severe adverse events	Low
Isolauri et al23	Finland	RCT	Hanifin criteria	Mild to moderate	B lactis and L rhamnosus GG	27	33	4.6 mo	Quantitative	NA	Low
Majamaa and Isolauri21	Finland	RCT	Hanifin criteria	Mild to moderate	Lactobacillus GG	31	NA	NA	Both	NA	Low
Passeron et al20	France	RCT	Criteria set by Williams	Moderate	Prebiotics and synbiotics	48	NA	5.85 y	Both	Mild abdominal pain in 1 case	Low
Prescott et al24	Australia	RCT	Hanifin and Rajka criteria	Moderate to severe	L fermentum	53	45.3	11 mo	Qualitative	NA	Low
Sistek et al19	New Zealand	RCT	Previously diagnosed	Moderate	L rhamnosus + B lactis	59	45.7	NA	Quantitative	NA	Low
Viljanen et al18	Finland	RCT	NA	Severe	Lactobacillus GG and mixed probiotics	230	NA	6.4 mo	Quantitative	2 cases developed severe AD and were then hospitalized	Low
Weston et al17	Australia	RCT	NA	Moderate to severe	L fermentum	56	46.5	10.9 mo	Both	No complication	Low

NA, Not available.

Publication bias and quality assessment

Publication bias was assessed using a funnel plot (Fig 2), which showed symmetry. There was no publication bias. All studies had a low risk of bias (Table II).16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29 All the studies had their parameters as “low” except the following: Brouwer et al²⁸ had moderate bias in “other sources of bias,” Holst et al²² had unclear bias in “sequence generation” and “allocation concealment,” and Isolauri et al²³ had moderate bias in “other sources of bias.”

Fig 2.

Funnel plot showed publication bias, which showed symmetry, and there is no publication bias.

Table II.

Results of the quality assessment of the included RCT

Study	Sequence generation	Allocation concealment	Blinding of participants	Blinding of outcome assessment	Incomplete outcome data	Selective outcome reporting	Other sources of bias	Net risk
Ahn et al16	Low	Low	Low	Low	Low	Low	Low	Low
Brouwer et al28	Low	Low	Low	Low	Low	Low	Moderate	Low
Cukrowska et al27	Low	Low	Low	Low	Low	Low	Low	Low
Grüber et al25	Low	Low	Low	Low	Low	Low	Low	Low
Gore et al26	Low	Low	Low	Low	Low	Low	Low	Low
Holst et al22	Unclear	Unclear	Low	Low	Low	Low	Low	Low
Isolauri et al23	Low	Low	Low	Low	Low	Low	Moderate	Low
Majamaa and Isolauri21	Low	Low	Low	Low	Low	Low	Low	Low
Passeron et al20	Low	Low	Low	Low	Low	Low	Low	Low
Prescott et al24	Low	Low	Low	Low	Low	Low	Unclear	Low
Rosenfeldt et al29	Low	Low	Low	Low	Low	Low	Low	Low
Sistek et al19	Low	Low	Low	Low	Low	Low	Low	Low
Viljanen et al18	Low	Low	Low	Low	Low	Low	Low	Low
Weston et al17	Low	Low	Low	Low	Low	Low	Low	Low

Results of quantitative analysis

Analysis was done to assess the efficacy of probiotics in AD using SCORAD. Ten studies in the forest plot (Fig 3) were used to observe the comparison between probiotics and placebo using 2 subgroups (≤2 months and >2 months).16, 17, 18, 19, 20, 21, 22, 23^,27,28

Fig 3.

Forest plot comparing probiotics and placebo for SCORAD score.

Six studies^17,18,20, 21, 22, 23 were used in the first subgroup that showed there was a statistically nonsignificant difference in SCORAD values within the first 2 months of the treatment between the groups (SMD, −0.04 [95% CI, −0.24 to 0.16]; P = .71; I² = 52%). A total of 197 patients were present in the probiotics group, whereas 195 patients were present in the placebo group. Only Isolauri et al²³ showed that there was statistically significant effect of B lactis Bb12 probiotic for treating the observed condition (SMD, −1.38 [95% CI, −2.43 to −0.32]; P = .0074). The rest of the studies were statistically nonsignificant, which led to an overall nonsignificant result as mentioned earlier.

After 2 months, there was a statistically significant decrease seen in SCORAD values in probiotics (SMD, −0.20 [95% CI, −0.36 to −0.03]; P = .02; I² = 77%).^{16,17,19,20,27,28} This subgroup had 488 patients being treated with probiotics and 501 being treated with placebo. Two studies were statistically significant in this group: Weston et al¹⁷ (SMD, −0.73 [95% CI, −1.28 to −0.19]; P = .0073) and Passeron et al²⁰ (SMD, −2.46 [95% CI, −3.32 to −1.61]; P = .0001). Both studies showed that children with eczema had better SCORAD results when they were treated with probiotics than patients treated with placebo. Overall results showed that probiotics significantly decreased SCORAD values (SMD, −0.13 [95% CI, −0.26 to −0.01]; P = .04; I² = 69%).^17,20 This showed that probiotics had a significant effect on treating eczema. Sensitivity analysis was done by removing 1 study at a time and assessing the results. In 2 studies,^17,20 it was observed that by removing results of subgroup 2, overall results significantly changed, showing that these 2 studies held weightage in the final result and in subgroup 2.

Results of qualitative analysis

Nine studies were used to analyze qualitatively how probiotics affected patients with AD.^16,17,20, 21, 22^,24, 25, 26, 27 Adverse events were described by 3 studies.^17,20,22 Statistically there was no significant difference in the events compared with both groups but diarrhea, nausea, and vomiting were the most common adverse effects seen. Fever was also observed in both groups but was not essentially related to the treatment. Weston et al¹⁷ reported a statistically significant difference in respiratory infection in the placebo group (P = .04). Three studies^16,21,27 described the changes in IgE levels and eosinophil levels after the treatment. Although there was no significant difference between the groups, Ahn et al¹⁶ showed that there was a significant increase in log IgE in the placebo group 1 year after the treatment (P = .044). Prescott et al²⁴ showed that there was a significant increase in IFN-γ (P = .046) and TNF-α (P = .018), which improved the body’s immunity to fight mitogens.

Itching, improvement in the condition, and overall quality of life were noted by 3 studies.25, 26, 27 In the long-term after treatment, it was seen that there was no significant difference, but in the short-term, improvement was significantly seen in the probiotics group (P = .012). Also, no significant effect was made by these groups on the use of supplementation such as corticosteroids. Hence, the use of probiotics is seen, and overall the effect of probiotics is superior to placebo, especially for short-term effects.

Discussion

This systematic review and meta-analysis evaluates the effects of probiotics on AD in children and adolescents, supporting the role of probiotics as the adjunct therapy in AD. The quantitative evidence supported the role of probiotics in reducing the severity of AD after 2 months of treatment, highlighting the time-dependent therapeutic effects of probiotics, which is more pronounced after a sustained period of treatment. The quantitative analysis highlighted the safety profile of probiotics, which showed no difference in the prevalence of adverse effects between the probiotics and placebo groups. However, the rate of respiratory infections was more prevalent in the placebo group, suggesting a potential role of probiotics against the infections, aligning with the current literature suggesting the immune-protective role of probiotics.^12,13,30, 31, 32, 33

The results highlighted the potential role of probiotics in the improvement of the quality of life. The children in the probiotics group reported a reduction in distressing symptoms of AD such as itching and redness. The findings were more pronounced in short-term treatment, with significant improvements in the first 2 months of treatment. Despite the long-term evidence for probiotics being less consistent, the rapid clinical relief suggested the potential for long-term adherence and overall satisfaction with the treatment and suggested the clinical effectiveness of probiotics in addition to conventional therapies.³⁴ In addition, the reductions in SCORAD values and symptom severity in the probiotics group suggested their role as a steroid-sparing option, considering the long-term adverse effects of the corticosteroids.³⁵ The minimal risk profile of probiotics makes them an attractive option for pediatric populations.

The qualitative analysis highlighted the immune modulation effect of probiotics; however, we found no changes in immunologic markers such as IgE and eosinophil levels. Prescott et al²⁴ reported an increase in levels of IFN-γ and TNF-α in probiotics groups, highlighting the enhanced immune response to combat infection and maintain homeostasis. The effect of probiotics on the regulation of the gut-skin axis further highlights the potential therapeutic effectiveness of probiotics.³⁶

Panduru et al³⁷ reported a significant decrease in AD occurrence. They found that prenatal followed by postnatal administration of probiotics was more protective than postnatal administration. Their subgroup analysis suggested that Lactobacillus with and without Bifidobacterium were effective. Several meta-analyses concluded that the effectiveness of probiotics used by pregnant women or breast-feeding mothers or administration in infants reduces the risk of AD; however, the high heterogeneity among studies decreases the reliability of the results.38, 39, 40 However, the recent evidence concluded by Wang et al⁴¹ from 72 included studies found that the early introduction of probiotics in infants protects against the development of allergic diseases. The literature supported the preventive effect of probiotics on AD; however, the therapeutic effect is less evident.

Lee et al³⁰ published the first meta-analysis to evaluate the prevention and treatment effectiveness of probiotics in AD in pediatric patients; however, their results supported the prevention potential of probiotics, and the treatment potential was inconclusive. A recent meta-analysis conclusion from 20 studies including the probiotics, synbiotics, and postbiotics intervention reported significant improvement in SCORAD score; however, the high in-study and subgroup heterogeneity and lack of robust results due to lack of updated nomenclature for probiotics use in included studies and the difference in age and administration technique were some limitations.³⁵ However, similar limitations were found in previous meta-analyses on this subject.^12,13,41,42

In our study, we included more evidence from recently published trials and specifically addressed the results for probiotics with the evidence pooled from 14 RCTs; however, the heterogeneity among the studies was evident. It could be explained that the heterogeneity was due to the use of different strains.

Gao et al³⁶ explained the role of probiotics in skin health and related gut-skin axis. Probiotics, including species such as Nitrobacter, Lactobacillus, and Bifidobacterium, play a significant role in improving skin diseases by restoring intestinal homeostasis. They achieve this by repairing gut microbiota imbalances and intestinal mucosal damage, which in turn helps to address skin issues. These probiotics can mitigate skin conditions such as acne, AD, psoriasis, and photoaging by reducing oxidative stress, inflammation, and immune dysregulation. In addition, they contribute to extracellular matrix remodeling, thereby promoting better skin cell function, collagen production, and overall dermal health, ultimately aiding in the treatment of various skin diseases.

Lactobacillus has shown significant promise in treating skin inflammation and damage. It has anti-inflammatory effects on skin cells and can inhibit harmful bacteria such as S epidermidis. Lactobacillus also helps in restoring skin barrier function and reducing inflammation, particularly in cases of UV-induced skin damage. Clinical studies have demonstrated that Lactobacillus interventions can improve skin immune function and even alleviate skin conditions such as adult acne. Furthermore, Lactobacillus, in combination with other probiotics such as Bifidobacterium, can protect skin fibroblasts from senescence, enhancing the skin’s resilience against oxidative stress and UV-induced aging.³⁶ A network meta-analysis reported the significant clinical effectiveness in Lactobacillus species, reporting L fermentum VRI-003 as the highest, whereas the lowest ranked strain is L rhamnosus GG.³² This could potentially explain the heterogeneity. Standardizing probiotic formulations, dosages, and treatment durations in future research would enhance the comparability of results and facilitate meta-analyses.

In addition, the funnel plot indicates no significant publication bias, and selective reporting remains a potential limitation, particularly given the variability in outcomes reported across studies. Long-term follow-up studies are also needed to assess the sustained effects of probiotics on AD and their impact on disease progression and recurrence. The geographic diversity of the included studies also results in heterogeneity. Although the inclusion of trials from multiple regions enhances the generalizability of the findings, it also introduces variability in dietary habits, environmental exposures, and health care practices, which may influence outcomes. Future studies should consider stratifying results by region or population characteristics to better understand these contextual factors.

Overall, this study has important implications for clinical practice. Probiotics represent a promising adjunctive therapy for AD, particularly for short-term symptom relief and improvement in overall quality of life. Their minimal risk profile and potential to modulate immune responses make them an appealing option for pediatric patients, who may be more susceptible to the side effects of conventional treatments. Further studies are needed to confirm the clinical role of probiotics for AD, particularly for patients with mild to moderate disease severity who are seeking noninvasive and holistic treatment options. However, it is essential to counsel patients and caregivers on the variability in probiotic formulations and the importance of selecting evidence-based products with demonstrated efficacy. Another area for future research is the exploration of synergistic effects between probiotics and other interventions. For example, combining probiotics with prebiotics, which serve as a food source for beneficial gut bacteria, could enhance their efficacy. Similarly, integrating probiotics with dietary modifications or other nonpharmacologic interventions could offer a more comprehensive approach to AD management. Understanding the mechanisms of action of different probiotic strains and their interactions with the host microbiome and immune system will also be critical for optimizing their therapeutic potential.

Conclusion

This systematic review and meta-analysis provides some evidence supporting the use of probiotics as an adjunctive therapy for AD in children. The observed reductions in SCORAD scores and improvements in quality of life underscore their potential to address both the physical and emotional burden of the disease for a short duration of time; however, they did not improve clinical outcomes. Although further research is needed to standardize probiotic interventions and explore their long-term effects, the efficacy of strain-specific probiotics in AD will need to be further studied and confirmed. By addressing the underlying immune dysregulation and enhancing gut-skin axis interactions, probiotics offer a novel and promising approach to improving outcomes for patients with AD.

Disclosure statement

This study was supported by the Open Project Fund of the State Key Laboratory of Pathogenesis, Prevention, and Treatment of Central Asian High Incidence Diseases (grant no. SKL-HIDCA-2024-GB9) and the Tianshan Talent High-Level Medical and Health Personnel Training Program of the Health Commission of Xinjiang Uygur Autonomous Region (grant no. TSYC202301B003)

Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest.