الفهرس 
Atopic DermatitisOnly 14 pages are availabe for public view
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Abstract
Atopic dermatitis has been well recognized for its major health burden, which
seems to be proportional to gross domestic product, affecting up to 20% of
children and 10% of adults. Extensive research revealed a complex
aetiopathogenesis of the disease, where gut microbiome would play an
underpinning role into the development and course of the disease. Gut dysbiosis,
as shown by lower diversity, increased pathobionts and decreased relative
abundance of short chain fatty acid producers, has been reproducibly
demonstrated in patients with AD.
In view of the chronic relapsing nature of the disease and subsequently the need
for repetitive courses of topical and systemic therapies with their recognized local
and systemic adverse effects, there has been a long pursuit for safe and
inexpensive alternative therapeutic options. In this context, modulating gut
microbiome, is a potential therapeutic target and is currently under extensive
research. Probiotics have been utilized in many clinical trials for the management
of AD with promising results. However, there has been inconsistency between
different studies on the duration of treatment, probiotic strains administered, age
of the recipient patients and whether probiotics were used as adjunctive therapy
to steroids, which might explain the difference in clinical outcome.
This study is a prospective controlled pilot study to define microbiome patterns
in patients with AD and to explore the therapeutic potential of probiotics as a solo
treatment conducted on an Egyptian cohort of patients with moderate to severe
AD. To the best of our knowledge, this is the first study to investigate the
feasibility of utilization of probiotics as a solo treatment of acute exacerbation of
AD in a head-to-head comparison with systemic steroids. After ethical approval, patients with SCORAD score ≥ 25 were allocated to either tapering course of steroids, starting at 0.5 mg/kg or probiotics (a mixture of 2 lactobacilli strains;
Lactobacillus delbruekii and lactobacillus fermentum at a dose of 1 X 109 CFU
twice daily for 3 weeks. Initially, 29 patients were enrolled for the trial (15
allocated to steroid, and 14 to probiotic). Ten patients in total dropped out
throughout the study course with 19 patients left to final per-protocol analysis (11
in probiotic group and 8 in steroid group). After 3 weeks of intervention, patients
were assessed for clinical improvement (as primary outcome) based on the
change in SCORAD index. Patients provided stool samples at baseline and after
treatment in both groups for gut microbiome assessment, via 16s rRNA
sequencing, to explore any underpinning microbiome changes that might
contribute to potential clinical improvement (as a secondary outcome).