Dermatology · Medical Literature
Efficacy of probiotics in preventing atopic dermatitis in infants: A systematic review and meta-analysis.
Abstract
ObjectiveAlthough probiotic modulation of the gut microbiota in early life has been proposed to prevent atopic dermatitis, supportive evidence remains inconsistent. This systematic review and meta-analysis aimed to determine whether probiotic supplementation initiated during infancy (0-36 months) reduces the risk of atopic dermatitis and provide clinically relevant insights.MethodsThe PubMed, Web of Science, EMBASE, and Cochrane Library databases were searched up to 8 January 2026 for randomized controlled trials comparing probiotics with placebo or no intervention for the prevention of atopic dermatitis. To be eligible, studies needed to have enrolled infants aged 0-36 months. Risk of bias was assessed using the Cochrane risk of bias 2 tool, and a random-effects meta-analysis was performed.ResultsEighteen randomized controlled trials (10,195 participants) were included. Pooled analysis showed that there was no significant protective effect of probiotics against atopic dermatitis (risk ratio = 0.94; 95% confidence interval: 0.72-1.25; p = 0.66), with substantial heterogeneity (I2 = 72.8%). Sensitivity analyses confirmed robustness, and no publication bias was detected (Egger's test, p = 0.15). Two studies featured a high risk of bias, predominantly due to missing outcome data.ConclusionsCurrent evidence does not support routine probiotic supplementation initiated only during infancy for the prevention of atopic dermatitis. Positive preventive effects reported in previous meta-analyses are largely driven by perinatal (maternal-plus-infant) regimens, whereas infant-only supplementation has failed to demonstrate consistent benefit.INPLASY registration number: INPLASY202650128.
Clinical relevance
Atopic dermatitis affects a significant proportion of the pediatric population, and there is growing clinical interest in early-life microbiome modulation as a preventive strategy. Despite widespread probiotic use in infant care, the evidence base for infant-only supplementation has remained inconsistent and conflated with perinatal (maternal-plus-infant) regimens in prior meta-analyses. This rigorously conducted systematic review isolates the effect of infant-only probiotic supplementation (ages 0–36 months), providing clinicians with a more precise and actionable evidence assessment for this specific intervention window.
Key findings
1. Pooled analysis of 18 RCTs (N = 10,195 participants) demonstrated no statistically significant protective effect of infant-only probiotic supplementation against atopic dermatitis (RR = 0.94; 95% CI: 0.72–1.25; p = 0.66). 2. Substantial heterogeneity was identified across included trials (I² = 72.8%), indicating marked variability in study populations, probiotic strains, dosing regimens, and outcome definitions. 3. Sensitivity analyses confirmed the robustness of the null finding, supporting the stability of the primary pooled estimate across methodological variations. 4. No publication bias was detected by Egger's test (p = 0.15), strengthening confidence that the null result is not an artifact of selective reporting. 5. Risk of bias assessment using the Cochrane RoB 2 tool identified two studies at high risk of bias, primarily attributable to missing outcome data. 6. The authors noted that positive preventive effects reported in earlier meta-analyses were largely attributable to perinatal regimens (combined maternal antenatal plus infant postnatal supplementation), not infant-only interventions.
Practice implications
Clinicians should not recommend routine probiotic supplementation initiated solely during infancy (0–36 months) for the primary prevention of atopic dermatitis, as current pooled evidence from 18 RCTs does not support efficacy for this intervention strategy. If probiotic-based prevention is being considered for high-risk infants (e.g., positive family history of atopy), the available evidence more strongly supports perinatal regimens that include maternal supplementation in the antenatal period combined with postnatal infant supplementation, rather than infant-only initiation. Future prescribing and research efforts should prioritize strain-specific, dose-defined perinatal protocols and address the substantial heterogeneity in existing trials before any guideline-level recommendation can be made.