Thomas Jayakar, Sachdeva Maleeka, Dhar Sandipan, Ganjoo Anil, Shah Bela, Pandhi Deepika, Lahiri Koushik, Agarwal Rashmi, Jagadeesan Soumya, Mane Pradeep, Nair Rathish, Korukonda Krishnaprasad R
Dermatology, Jayakar Thomas Skin Care Centre, Chennai, IND.
Dermatology, Sachdev Clinics, Chandigarh, IND.
Cureus. 2024 Jul 15;16(7):e64583. doi: 10.7759/cureus.64583. eCollection 2024 Jul.
Background Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by intense itching and recurrent eczematous lesions. Important factors in the etiopathogenesis of AD include genetic predisposition, epidermal barrier dysfunction, immune dysregulation, and gut and skin dysbiosis. Probiotics could be a potential preventive strategy for allergies including AD through immune system modulation as well as enhancement of the epithelial barrier integrity. To further understand the role of probiotics in the management of AD, a Knowledge, Attitude, and Practices (KAP) survey was conducted. Materials and methods A steering committee comprising nine experts formulated consensus recommendations on the role of probiotics in the management of AD and associated flare-ups through the use of the Knowledge, Attitude, and Practices questionnaire while analyzing literature reviews and responses from a national panel consisting of 175 members. The evidence strength and quality were evaluated based on the Agency for Healthcare Research and Quality (AHRQ) criteria. The acceptance of expert opinions as recommendations was considered upon receiving an endorsement from ≥70% of the panelists, as indicated by a Likert scale. Results The national panel emphasized that the improvement in nutritional status, immunomodulatory properties, and beneficial effects on the gastrointestinal (GI) tract and skin support the use of probiotics in AD. The panel agreed that probiotics should be a part of the complementary therapy in the management of AD and associated flare-ups. Mostly, a probiotics supplementation duration of eight to 12 weeks is preferred by dermatologists. Probiotics, when used as an adjuvant therapy, may serve as a strategy to reduce steroid usage or maintenance therapy in high-risk cases with flares. Conclusion A Delphi-mediated KAP response provides a real-life approach to the use of probiotics in the management of AD. It suggests that probiotics could be useful as an adjuvant therapy in the management of AD and associated flare-ups when used along with traditional treatment.
背景 特应性皮炎（AD）是一种慢性炎症性皮肤病，其特征为剧烈瘙痒和反复出现的湿疹样皮损。AD发病机制中的重要因素包括遗传易感性、表皮屏障功能障碍、免疫失调以及肠道和皮肤微生物群失调。益生菌可能是包括AD在内的过敏症的一种潜在预防策略，可通过调节免疫系统以及增强上皮屏障完整性来实现。为了进一步了解益生菌在AD管理中的作用，开展了一项知识、态度和实践（KAP）调查。
材料和方法 一个由九名专家组成的指导委员会通过使用知识、态度和实践问卷，在分析文献综述以及来自一个由175名成员组成的全国性小组的回复的同时，就益生菌在AD管理及相关病情发作中的作用制定了共识性建议。依据美国医疗保健研究与质量局（AHRQ）标准对证据的强度和质量进行了评估。如李克特量表所示，在获得≥70%的小组成员认可后，专家意见被视为建议接受。
结果 全国性小组强调，营养状况的改善、免疫调节特性以及对胃肠道（GI）和皮肤的有益作用支持在AD中使用益生菌。该小组一致认为，益生菌应成为AD管理及相关病情发作辅助治疗的一部分。大多数情况下，皮肤科医生更倾向于使用八至十二周的益生菌补充疗程。益生菌作为辅助治疗时，可作为一种策略，用于减少高危发作病例中的类固醇使用或维持治疗。
结论 德尔菲法介导的KAP回应为益生菌在AD管理中的应用提供了一种实际可行的方法。这表明，益生菌与传统治疗联合使用时，可作为AD管理及相关病情发作的辅助治疗手段。
