INTRODUCTION
Atopic dermatitis (AD) is the most common skin disorder among children. As a chronic inflammatory disorder, it is considered a psychologically burdensome pediatric concern and affects 15 to 20% of children worldwide.1-3 Probiotics are live microbial agents that have been increasingly used for various disease conditions over the past two decades.4 While its effect on AD has been studied extensively, concerns about the safety of administering live microbes in children instigated further research for alternative approaches in AD management.1
Recent studies show increasing interest in the potential clinical application of postbiotics to prevent and treat AD.5-13 Postbiotics are defined as “preparations of inanimate microorganisms and/or their components that confer a health benefit on the host”.14 Aside from mutually benefiting hosts, another similarity between probiotics and postbiotics is their high strain-specificity. In postbiotics, exopolysaccharides and lipoteichoic acid production are strain-specific behavior.15.
Postbiotics are promising alternatives to probiotics since these eliminate the risk of using live microbial strains, especially among individuals with weakened immune systems, and address product longevity concern14,16. Several randomized controlled trials (RCTs) have been conducted on this topic, with conflicting evidence. As of the writing of this paper, no systematic review and meta-analysis that evaluate the efficacy of postbiotic therapy for atopic dermatitis in children have been conducted. This network meta-analysis (NMA) aims to synthesize all available evidence and determine the efficacy and safety of various postbiotics preparations in treating pediatric AD.