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.