• Not all eczema treatments can be given to young children
• In a study, a topical probiotic against eczema was tested on children, with good results
• This fits in with evidence that eczema involves an imbalance in the skin’s microbiome

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Applying a type of “good” bacteria to the skin may relieve children of the itch and discomfort of eczema, a new, small study suggests.

Eczema is a chronic inflammatory condition that causes dry, itchy skin and scaly rashes. It usually starts in early childhood, and commonly occurs along with allergies like hay fever and asthma, according to the American Academy of Allergy, Asthma and Immunology.

There are numerous treatments for eczema, both topical and oral, but not all can be given to young kids.

“So, there’s a big need for safe and effective treatments for young children,” said study author Dr Ian Myles. He is a researcher and staff clinician with the US National Institute of Allergy and Infectious Diseases.

Imbalance in microbiome

For the study, his team tested a topical probiotic against eczema in 20 children as young as three years of age. Over four months, 17 of the 20 saw their rashes and itchiness fade by more than 50%.

The children were also able to cut down on topical corticosteroids, a standard treatment for eczema – but one that can cause side effects like thinning of the skin and stretch marks.

The probiotic therapy is a spray solution containing live Roseomonas mucosa bacteria. Those microbes are normally present on the skin, and past research has found that R. mucosa from people with healthy skin can treat eczema in lab mice.

In contrast, samples of the bacteria from people with eczema either had no effect, or made the skin condition worse.

It all fits with evidence that eczema involves an imbalance in the skin’s microbiome. That refers to the vast array of bacteria and other microbes that naturally dwell on the skin and help maintain its health.

Staph infections

The skin, Myles explained, has to repair itself from daily wear-and-tear, and the microbiome assists in that. He said R. mucosa appears to produce oils that aid the skin’s repair capacity.

The treatment also reduced staph bacteria on the children’s skin, and those microbes can worsen eczema symptoms.

Dr John Browning, a paediatric dermatologist, said, “I think this is a really interesting study.” Browning was not involved in the research.

He said people with eczema often get staph infections and need antibiotic treatment. It’s possible R. mucosa could be an alternative, according to Browning, who is based at Children’s Hospital of San Antonio and Texas Dermatology and Laser Specialists.

The findings, published online on 9 September in the journal Science Translational Medicine, are based on 20 children and teenagers who were given the probiotic therapy for four months. They (or their parents) applied the spray solution twice a week for three months, and then every other day for the final month.

Lasting benefits

On average, Myles said, the kids’ itchiness and rash improved by 60% to 75%, with no significant side effects.

And there were signs it could have lasting benefits. Eight months after the therapy was stopped, the good bacteria were still colonising the children’s skin – indicating R. mucosa had “moved in,” Myles explained.

That, he said, suggests the therapy could be one time only. It would still be possible, though, that whatever caused the bacterial imbalance in the skin could do it again.

Myles said a broader goal is to figure out what those factors are – with diet, soaps and antibiotics being among the suspects.

Browning is part of another trial testing R. mucosa for treating eczema. But he does not think it is the only bacterium that matters.

Further development

“There could be a lot of variability patient to patient in whether this approach would be helpful,” Browning said.

Myles agreed, noting that not all study patients responded to the probiotic.

It’s unclear when the R. mucosa therapy could become commercially available. The US National Institutes of Health has licensed it to a private company, Forte Biosciences, to further develop.

Myles said the company worked to freeze-dry the probiotic so it can be reconstituted with water, then sprayed on. That will make it shelf-stable.

“We anticipate this being something you can pick up at the pharmacy,” he said.

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