Eczema: Researchers report link with gut health in babies

• About 6% of children globally have eczema, also known as atopic dermatitis.
• While some children may outgrow eczema, many do not and experience worsened conditions.
• Researchers from The Chinese University of Hong Kong say they have found evidence suggesting a link between the gut microbiome and eczema during infancy, which may provide potential prevention and treatment options.

About 6% of children around the world have eczema — a chronic inflammatory skin disorder that can cause itchy, cracked, and dry skin.

Clinically known as atopic dermatitis, this skin condition currently has no cure.

Although some infants and children outgrow their eczema, many do not and the condition may worsen as they get older.

Now, researchers from The Chinese University of Hong Kong say they have found evidence suggesting a link between the gut microbiome and eczema during infancy, a discovery that could provide potential prevention and treatment options.

The study was recently published in mSystems, a journal of the American Society for Microbiology.

Why do babies get eczema?

While eczema can occur at any age, previous research shows almost half of all diagnoses occur within the first year of life and about 85% by 5 years of age.

Currently, researchers do not know the exact cause of atopic dermatitis. However, they do know certain genetic and environmental factors can aggravate a baby’s sensitive skin, causing eczema.

Some of these factors include:

• allergic reaction to laundry detergent, bath soap, and/or foods
• irritation caused by pollution, tobacco smoke, extreme temperature changes, and other environmental factors
• overreaction of the immune system
• genetic predisposition to eczema, asthma, and/or allergies
• genetic mutation that affects the protective layer of a baby’s skin

Eczema symptoms may vary by person and age. Symptoms of infant eczema generally include a dry, scaly rash on the scalp, face, and areas where there are large joints such as the knees and elbows. The rash may itch and ooze if scratched.

After the age of 2, children may see signs of eczema in the creases of knees and elbows, as well as the neck, ankles, and wrists.

Doctors can treat the skin to keep it hydrated and help reduce inflammation. Common treatments include medicated topical creams and ointments and therapies called biologic drugs that help calm the immune system and inflammation.

Additionally, physicians may recommend using creams to keep the skin moist, avoiding allergic triggers as well as wearing clothing made of only natural fibers, and using mild and unfragranced soap.

October is Eczema Awareness Month and the National Eczema Association offers additional resources on eczema symptoms and treatments.

The gut microbiome and eczema 

For this study, researchers recruited pregnant women who were close to delivery to participate in the study. Information was taken on their health and lifestyle both during pregnancy and after delivery.

Researchers collected diet, medication, and health information on 112 infants after they were born. Scientists also kept abreast of any eczema issues and followed the development of each baby’s gut microbiome by collecting nine stool samples over the child’s first three years of life.

“The problem of eczema is increasing, and our study shows it could be a result of unwanted changes in the gut bacterial content,” explained Dr. Paul Chan, a professor of microbiology at The Chinese University of Hong Kong and principal investigator of the study. “The first year of life could be a critical period to restore the gut bacteria to a more desirable composition.”

Previous research shows the health of an infant’s gut microbiome plays an important role in infant development and sets the tone of a person’s overall health as they age.

Gut microbiome changes with eczema

Upon analysis, researchers reported they found differences in the composition and diversity of gut microbiota across the first three years of the infants’ life.

They said they discovered that how a baby is delivered, what antibiotics they are given during labor, and how they are fed influence how the gut microbiome is established over the first 12 months of life.

Additionally, scientists also found certain changes in an infant’s gut microbiome occurred right before they were diagnosed with eczema. This included a lack of a species of bacteria called Bacteroides and too much of another type of bacteria called Clostridium sensu stricto 1.

Researchers also reported these same patterns were observed in babies delivered via C-section, suggesting the gut microbiome may play a role in previously reported associations between C-section delivery and increased risk of eczema.

Experts react to study on babies and eczema

After reviewing the research, Dr. Peter Lio, a clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine in Chicago, told Medical News Today that the results of this study are confirmatory and not surprising.

“In the past several years there have been a number of papers that have shown very similar findings and we are beginning to better understand this connection between the gut microbiome and the skin,” he said. “It is a very important part of this story and has been shown to be predictive of (the) development of atopic dermatitis from the earliest time points.”

Dr. Ashanti Woods, a pediatrician at Mercy Medical Center in Baltimore, agreed.

“This is really good to know and helpful as it may impact our decisions in the future regarding whether we introduce antibiotics to moms and in discussions pertaining to elective C-sections,” Woods, who also was not involved in the study, told Medical News Today. “There has long been a known association between the gastrointestinal system and the skin. In fact, many gastrointestinal disorders, such as Crohn’s disease or celiac disease, have dermatologic manifestations and symptoms. As such, it is insightful to hear that perinatal and postnatal exposures to the fetus and infant can, in fact, have a risk potential on the development of eczema.”

Where more atopic dermatitis research is needed

When it comes to the next steps for this research, Woods said he would like to see more diversity.

“I would like to see this study replicated in other regions, where the diet and environmental factors may differ somewhat, to see if the results are similar,” he added.

Lio added we need to have a better understanding of why the gut microbiome is disordered and why the skin microbiome mirrors this.

“One bigger theory is attributed to Professor C. Akdis and his remarkable epithelial hypothesis: in short, the first problem is a leaky gut and leaky skin barrier, and then the bacterial imbalance (dysbiosis) follows that,” Lio said. “A number of environmental factors, including things like microplastics and pollutants seem to contribute to this. However, it is not without criticism. I would like to see actionable ideas for therapy.”

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