Probiotics, Prebiotics, Enzymes: What People With Eczema Need to Know

This photo shows an assortment of fresh, prebiotic-rich foods, including berries, asparagus and leeks. The foods are arrayed attractively in bowls on a white survace.

By Angela Ballard, RN

Published On: Feb 28, 2022

Last Updated On: Feb 28, 2022

There’s a lot of buzz about the importance of a healthy microbiome, and at least one study has shown that an imbalance in the gut-skin axis may be linked to eczema and other skin conditions.

But does it follow that “feeding” your microbiome with additional good bacteria (probiotics), prebiotics or enzymes can help prevent or improve skin problems?  Here’s what the science says.

What do I need to know about probiotics?

Probiotics are microorganisms in the human body that serve many crucial functions for health and research suggests that people with more diverse microbiomes may be healthier overall. Probiotics come into play because they are supplements or foods containing “good” bacteria similar to those that naturally live in and on our bodies. Some believe that by taking probiotics you can augment your beneficial population of probiotics so they can keep doing their jobs – or do them better. But there isn’t great evidence to support this notion, yet … especially when it comes to skin care.

Dr. Richard Gallo, PhD, distinguished professor of dermatology and chair of the department of dermatology at UC San Diego School of Medicine, said: “Although there is a lot of discussion and some observations in support of [probiotics], the evidence for oral microbial therapy in eczema is not strong. The consumer needs to proceed with caution in this area. Individual responses appear to differ greatly.”

Probiotics for use on top of the skin (topical) may, however, have some solid science to back them up. Gallo explained that he and his colleagues “have conducted double blind, placebo controlled trials of bacterial therapy for topical application in eczema that have shown effectiveness. The evidence suggests it is helpful for the moderate to severe atopic patient.” In one study, Gallo and fellow researchers used a universal strain of bacteria from healthy human skin to treat common eczema. Two-thirds of study participants reported improvements in their skin symptoms, including less itch and inflammation.

Considering probiotics? The good news is that oral probiotics are, in general, considered safe and don’t usually cause side effects (beyond mild gas). They aren’t, however, a good idea for people who are immune-compromised, have a serious underlying medical condition, recently had surgery or are being treated for cancer; in any these situations, or before considering probiotics for a baby or young child, be sure to talk to your doctor first.

What do I need to know about prebiotics?

Prebiotics are the substances “good” bacteria use in order to grow. Prebiotics are found in the fiber we eat but don’t digest (“roughage”). Prebiotics’ possible benefits are still being researched, so the jury is still out about whether it’s necessary to take them in extra amounts, or not.

Fortunately, prebiotics naturally occur in a lot healthy foods, so if you add more of these to your diet, you can’t really go wrong:

  • Asparagus
  • Bananas
  • Berries like blueberries
  • Leeks
  • Legumes
  • Nuts and seeds
  • Oats
  • Soy beans
  • Spinach
  • Whole wheat

You don’t need to eat a lot prebiotics. The International Scientific Association for Probiotics and Prebiotics recommends only 5 grams of prebiotics per day for gut health. If you consume recommended amounts of dietary fiber, you’re likely getting enough.

How do enzymes fit into all this?

Enzymes are proteins that are naturally produced in our bodies and used to speed up chemical reactions. Enzymes are found in our saliva, pancreas, intestines, and stomach and used for digestion and more. Having too much or too little of a certain enzyme can cause a health problem.

Only a blood test can determine your enzyme levels but if you are generally healthy, you are probably getting enough enzymes from a nutritious, balanced diet. If you have a particular medical condition (like pancreatic cancer, large pancreatic cysts, chronic pancreatitis, Fabry disease or Krabbe disease) your healthcare provider may recommend taking enzyme supplements.

Pancreatic enzyme supplements have been studied for children with eczema related to food allergies. Results from a small study showed that significant improvement in eczema was seen after 6 weeks of pancreatic enzyme supplementation in 81% of participants. The scientists involved, however, say that more research is needed before enzymes can be recommended for eczema care. If you’re wondering about enzymes and your health, ask your doctor if it might be useful to have your levels checked.

Key takeaways

The gut-skin connection is something the medical community is learning more about and we are hopeful that new, effective eczema management techniques will come out of improved understanding of the microbiome, skin, and ways to improve how the two interact.

In the meantime, while there isn’t clear, definitive information to support probiotics, prebiotics or enzymes for eczema relief, we hope you’ll keep considering your options and talk to your healthcare providers about whether these might be worth a try in your individual situation.

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