Correspondence

Atopic Dermatitis

N Engl J Med 2005; 353:1069-1070September 8, 2005

Article

To the Editor:

In his thorough Clinical Practice article (June 2 issue),1 Williams quotes two review articles2,3 as his sources when he states, “Studies have failed to show clinically useful benefits from . . . viable lactobacilli (probiotics).” Since the publication in January 2005 of the article that specifically reviews probiotics,3 two double-blind, placebo-controlled, randomized trials have been published that contradict Willliams's conclusion. With supplementation with probiotics, Viljanen et al.4 found significant improvement on the Scoring Atopic Dermatitis (known as SCORAD) index only in “IgE-sensitized infants,” but the improvement found by Weston and colleagues5 did not have such limitation.

Atopic dermatitis is one of our greatest therapeutic challenges. As noted in Table 3 of Williams's article, all our treatment options carry potential risks, most far greater than the minimal risk associated with probiotics.

Valori Treloar, M.D.
Integrative Dermatology, Newton, MA 02461

5 References

1
Williams HC. Atopic dermatitis. N Engl J Med 2005;352:2314-2324
Full Text | Web of Science | Medline

2
Hoare C, Li Wan Po A, Williams H. Systematic review of treatments for atopic eczema. Health Technol Assess 2000;4:1-191
Medline

3
Probiotics for atopic diseases. Drug Ther Bull 2005;43:6-8
CrossRef | Medline

4
Viljanen M, Savilahti E, Haahtela T, et al. Probiotics in the treatment of atopic eczema/dermatitis syndrome in infants: a double-blind placebo-controlled trial. Allergy 2005;60:494-500
CrossRef | Web of Science | Medline

5
Weston S, Halbert AR, Richmond P, Prescott SL. Effects of probiotics on atopic dermatitis: a randomised controlled trial. Arch Dis Child (in press).

Author/Editor Response

Although Dr. Treloar cites two new studies as contradicting my conclusion that a useful benefit of probiotics for atopic dermatitis has yet to be demonstrated, neither study shows any statistically significant difference between probiotics and placebo for the primary outcome measures. It is true that the study by Viljanen et al. found a small beneficial difference in a subgroup of sensitized children, but this was an exploratory analysis.1 The study by Weston et al. highlighted changes in disease severity over time in the probiotic and placebo groups independently, yet the test of difference between the treatments for the primary outcome measure did not show significance.2

Probiotics may be useful in atopic dermatitis,3 but four trials summarized in a recent review,4 plus the two cited by Dr. Treloar,1,2 have failed to show significant differences for their primary outcomes. A systematic review is needed to summarize the evidence.

Hywel C. Williams, Ph.D.
University of Nottingham, Nottingham NG7 2UH, United Kingdom
hywel.williams@nottingham.ac.uk

4 References

1
Viljanen M, Savilahti E, Haahtela T, et al. Probiotics in the treatment of atopic eczema/dermatitis syndrome in infants: a double-blind placebo-controlled trial. Allergy 2005;60:494-500
CrossRef | Web of Science | Medline

2
Weston S, Halbert AR, Richmond P, Prescott SL. Effects of probiotics on atopic dermatitis: a randomised controlled trial. Arch Dis Child (in press).