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Probiotik untuk merawat ekzema

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Abstract

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Background

Probiotics have been proposed as an effective treatment for eczema, and recently a number of clinical trials have been undertaken.

Objectives

To assess the effects of probiotics for the treatment of eczema

Search methods

We searched the Cochrane Skin Group Specialised Register (to April 2008), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2,2008) MEDLINE (from 2003 to April 2008), EMBASE (from 2005 to April 2008), PsycINFO, AMED and LILACS (from inception to April 2008) and ISI Web of Science (to December 2006) and reference lists of articles. We also searched registries of ongoing clinical trials, conference proceedings and searched for adverse events.

Selection criteria

Randomised controlled trials of live orally ingested microorganisms for the treatment of eczema.

Data collection and analysis

Two authors independently applied eligibility criteria, assessed the quality of trials and extracted data. We contacted study authors for more information where necessary. We recorded adverse events from the included studies, and from the separate adverse events search.

Main results

Twelve randomised controlled trials involving 781 participants met the inclusion criteria. All trial participants were children. There was no significant difference in participant or parent‐rated symptom scores in favour of probiotic treatment (5 trials, 313 participants). Symptom severity on a scale from 0 to20 was 0.90 points lower after probiotic treatment than after placebo (95%CI ‐1.04, 2.84; p = 0.36).There was also no significant difference in participant or parent‐rated overall eczema severity in favour of probiotic treatment (3 trials, 150 participants). There was no significant difference in investigator rated eczema severity between probiotic and placebo treatments (7 trials, 588 participants). On a scale from 0 to 102 investigator rated eczema severity was 2.46 points lower after probiotic treatment than after placebo treatment (95%CI ‐2.53, 7.45 p = 0.33). Significant heterogeneity was noted between the results of individual studies, which may be explained by the use of different probiotic strains. Subgroup analysis by age of participant, severity of eczema, presence of atopy or presence of food allergy did not identify a population with different treatment outcomes to the population as a whole. The adverse events search identified some case reports of infections and bowel ischaemia caused by probiotics.

Authors' conclusions

The evidence suggests that probiotics are not an effective treatment for eczema, and probiotic treatment carries a small risk of adverse events.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Ringkasan bahasa mudah

Probiotik untuk merawat ekzema

Tidak ada bukti yang cukup untuk mengesyorkan penggunaan probiotik untuk rawatan ekzema.

Ekzema adalah satu keadaan kulit yang dicirikan oleh ruam merah yang gatal, yang mempengaruhi antara 5 hingga 20% orang pada suatu masa dalam kehidupan mereka. Penghidap ekzema mempunyai bakteria yang berbeza dalam usus mereka berbanding dengan orang tanpa ekzema, dan kadang‐kadang mereka mempunyai keradangan dalam usus mereka. Adalah mungkin untuk merawat gejala ekzema dengan penukaran campuran bakteria usus atau dengan mengurangkan keradangan dalam usus. Satu jenis rawatan yang mungkin boleh mencapai matlamat ini adalah probiotik ‐ ini adalah mikroorganisma hidup yang diambil melalui mulut seperti bakteria Lactobacillus yang terdapat dalam susu tidak pasteur dan yogurt. Ulasan dua belas kajian ini mendapati bahawa probiotik tidak mengurangkan gejala‐gejala ekzema seperti gatal atau tidak juga mengubah tahap keterukan keseluruhan ekzema seperti yang dinilai oleh pesakit atau doktor mereka. Keputusan adalah berbeza di antara kajian‐kajian tetapi secara keseluruhan ia tidak menunjukkan bahawa probiotik adalah satu rawatan yang berkesan untuk ekzema. Kajian lanjut probiotik baru adalah diperlukan, kerana mungkin pelbagai jenis probiotik yang belum dikaji dalam rawatan ekzema boleh menjadi lebih berkesan. Probiotik jarang boleh menyebabkan jangkitan dan masalah usus.