A Clinical Study Of Probiotics In The Adjuvant Treatment Of Pediatric Atopic Dermatitis

BackgroundAtopic dermatitis(AD)is a chronic inflammatory skin disease related to genetic allergies.The main manifestations of atopic dermatitis are pruritus and polymorphic lesions.The disease is more common in children and adolescents,which has frequent recurrent episodes,seriously affecting the quality of life of patients.Its pathogenesis is not completely clear,involving environmental,genetic,immune and other factors.Many studies have shown that the imbalance of intestinal flora may be related to the pathogenesis of AD,so probiotics may be beneficial for the improvement of AD patients However,researches at home and abroad mainly focuses on the prevention of pediatric atopic dermatitis by probiotics at present,and involves less in the field of probiotic treatment.This study is a a prospective study of 60 children with AD to observe the efficacy of probiotics in the adjuvant treatment of AD and to explore the feasibility of its clinical application.ObjectiveTo analyze the efficacy of probiotics in the treatment of pediatric atopic dermatitis and its effect on pruritus degree and quality of life,to evaluate the safety of the medication and the recurrence of the condition,and explore the influencing factors of the treatment effect.MethodsThe cases included in this trial were 60 children with atopic dermatitis from 0-12 years old who were admitted to our hospital from June 2018 to January 2019.On the basis of the comparison principle,they were randomly divided into probiotics group and control group,then their basic information was collected by questionnaire.The probiotics group was treated with topical corticosteroids,0.03%tacrolimus,emollient combined with oral probiotics,while the control group only received topical corticosteroids,0.03%tacrolimus,emollients,all of them are treated for 4 weeks.The scoring atopic dermatitis index(SCORAD)was evaluated before treatment and at the end of the course of treatment.The efficiency was calculated according to the SCORAD score to compare the difference of the total effect between the two groups.Evaluation of various indexes of the patients before and after treatment,concluding objective SCORAD index,visual analogue scale(VAS),the infants’ dermatitis quality of life index(IDQOL)or children’s dermatitis life quality index(CDLQI),then compare them between the two groups at the end of the treatment.After treatment,the patients were followed up for 4 weeks.The number of recurrence in the control group and probiotics group were recorded,and the recurrence rates of the two groups were compared.Observe,record and deal with drug-related adverse reactions during treatment.According to feeding style and atopic tendency,the patients were divided into different subgroups.The modification of SCORAD scores caused by these two factors were compared with the treatment methods to evaluate whether there was any interaction between two factors and influence each other.ResultsThe total number of cases that have been though the trial was 56,including 28 cases in the control group and 28 cases in the probiotics group.There were 6 cases with mild type(10.71%),38 cases with moderate type(67.86%)and 12 cases with severe type(21.43%).There was no significant difference in age,sex,course of disease,SCORAD score,objective SCORAD score,VAS score and CDLQI/IDQOL score between the two groups before the trial(P>0.05).55 cases are collected during follow-up phase,including 27 cases in the control group and 28 cases in the probiotics group.1.The total effective rate of the probiotics group and the control group was 32.14%and 64.29%,.The recovery rate of the two groups was 0%,the explicit effective rates are32.14%,64.29%and the improvement rate are 60.71%,28.57%respectively.Statistical analysis showed that the total effective rate of probiotics was higher than that of control group,and the significant difference was observed between the two group(P=0.032<0.05).2.The indexes in control group and probiotics group were compared before and after treatment,including the SCORAD index,objective SCORAD index,VAS score and CDLQI/IDQOL score were significantly lower than those before treatment(P<0.001)3.The SCORAD score of the control group and probiotics group after treatment were 20.98 ±8.49 and 16.60 ±7.47respectively,which were significantly lower in the probiotics group than in the control group(P<0.05).The objective SCORAD score of the two groups after treatment were 15.38±6.45 and 12.21 ±5.16,respectively.4.Objective and subjective indicators:The scores of probiotics group were lower than those of the control group,the difference was statistically significant(P<0.05).There was no significant difference in VAS score and CDLQI/IDQOL score between control group and probiotics group after treatment(P>0.05).5.Recurrence rate and safety:with in 4 weeks after the experiment,the recurrence rate of control group and probiotics group were 22.22%and 17.86%,respectively.The control group was higher than probiotics group,but there was no significant difference(P = 0.686>0.05).No serious drug-related adverse reactions were found in the control group and probiotics group,mainly including mild diarrhea in the early stage,which is a self-healing symptom without special treatment.6.Speculative analysis about subgroups:there was no significant difference in the interaction on the SCORAD index between the two factors-feeding style and treatment methods-at the end of the test(P=0.514<0.05).Non-breastfeeding may have a strong effect on the difference of SCORAD scores caused by treatment.There was no significant difference in the interaction between the two factors-atopic tendency and treatment methods-at the end of the test(P=0.407<0.05).The influence of atopic tendency on the difference of SCORAD scores caused by treatment may be greater.Conclusion1.It is clear that the efficacy of probiotics in the treatment of pediatric atopic dermatitis,mainly in the improvement of objective symptoms,but the improvement of itching degree and quality of life is similar to that of routine treatment.Oral probiotics as an adjuvant therapy can not reduce the recurrence rate of the disease in the short term,which may be a safety therapy.2.Feeding pattern and atopic tendency may have no effect on the treatment of probiotics,children with non-breastfeeding and atopic tendency are reacted well to treatment probiotics.