This was a prospective, single-arm pilot study conducted in an urban pediatric primary care clinic in Texas. The study assessed changes in patient-reported symptom severity following initiation of daily oral probiotic supplementation over 12 weeks.

Children aged 0–15 years with clinician-diagnosed atopic dermatitis and persistent symptoms despite routine skin care measures were eligible. Diagnosis was based on clinical history and physical examination findings consistent with atopic dermatitis.

Exclusion criteria included prematurity, current probiotic use, prior intolerance to probiotics, or inability to take oral supplements. Participation was voluntary, and caregivers elected whether to initiate probiotic supplementation.

Participants initiated daily oral probiotic supplementation for 12 weeks. Commercially available multi-strain probiotic formulations were recommended based on clinician discretion and product availability. Formulation type (liquid, powder, chewable, or capsule) was selected according to patient age. Specific probiotic strains were not standardized across participants.

The primary outcome was change in symptom severity measured by the Patient-Oriented Eczema Measure (POEM), a validated 7-item patient-reported instrument assessing itching, sleep disturbance, bleeding, weeping, cracking, flaking, and dryness over the preceding week. Scores range from 0 to 28.

POEM was administered at baseline and at 4-, 8-, and 12-week follow-up visits. The primary comparison was between baseline and week 12 scores.

Secondary outcomes included:

Descriptive statistics were used to summarize demographic characteristics, adherence, and changes in POEM scores. Mean change and percent improvement were calculated as:

(baseline POEM − week 12 POEM) ÷ baseline POEM × 100.

This initiative was conducted as a clinical care improvement effort and was reviewed by clinic leadership and determined not to meet criteria for human subjects research under institutional policy. Therefore, institutional review board approval was not required. All data were collected as part of routine clinical care and analyzed retrospectively.

Seventeen children initiated probiotic supplementation and completed 12-week follow-up. The cohort included 10 males (58.8%) and 7 females (41.2%). Most participants were younger than 2 years (65%). Baseline POEM scores ranged from 1 to 23, with a mean of 10.41.

At week 12, mean POEM score decreased to 3.7, representing a mean change of -6.74 points and a mean percent improvement of 64%.

Fourteen of 17 participants (82%) demonstrated reduction in POEM score. Participants with moderate to severe baseline disease (POEM ≥8) experienced greater relative improvement compared with those with mild baseline disease.

By week 12, no participants remained in the severe or very severe POEM categories. Most participants (82%) were categorized as clear or mild.

Thirteen participants (76%) met adherence criteria (probiotic use ≥5 days per week). One participant reported mild gastrointestinal discomfort that resolved after discontinuation. No serious adverse events were reported.

In this prospective pilot study, daily oral probiotic supplementation was associated with meaningful reductions in patient-reported atopic dermatitis symptom severity over 12 weeks. Most participants experienced improvement, and the intervention was well tolerated.

Probiotic supplementation may represent a practical adjunctive strategy for pediatric patients whose families seek integrative approaches. Probiotics are widely available, generally safe, and relatively inexpensive. For children with moderate to severe baseline disease, observed improvements were particularly notable.

Use of a validated patient-reported outcome tool facilitated longitudinal monitoring and shared decision-making, supporting engagement in integrative management plans.

Prior randomized trials and meta-analyses have reported modest reductions in atopic dermatitis severity with probiotic supplementation, though heterogeneity in strains and dosing limits generalizability.^5–8 This study extends those findings by demonstrating symptom improvement in a real-world outpatient setting using commercially available products.

This study was single-arm and lacked a control group, precluding causal inference. Natural disease fluctuation, concurrent therapies, regression to the mean, or seasonal variation may have contributed to observed improvements. The small sample size limits generalizability. Probiotic strains were not standardized, preventing strain-specific analysis. Additionally, adherence was self-reported.

Daily oral probiotic supplementation was associated with reductions in patient-reported atopic dermatitis symptom burden in this pilot cohort. For integrative dermatology clinicians, probiotics may serve as a reasonable adjunctive strategy in selected pediatric patients. Larger randomized controlled trials with standardized formulations are needed to confirm efficacy and identify optimal strains and dosing.

The author declares no conflicts of interest.