By Morgan Helmling, BHSc (Naturopathy), Living Holistic Health — an evidence review of probiotics for eczema in children, and where omega-3 fits.
It is a particular sound, and if you have heard it you already know the one I mean.
Three in the morning. The small dry rasp of fingernails on skin, coming from the next room. Not crying, which would at least be something you could go and settle. Just scratching, on and on, while a child who desperately needs to sleep works at their own arms in the dark.
Parents do not come to me about eczema because of a rash. They come because of that sound, and because of what a fortnight of it does to everybody in the house.
Which is exactly why probiotics get bought. Standing in a pharmacy aisle at nine at night, holding a box that promises to help from the inside, is a very reasonable thing to do. So this article is about what those boxes can and cannot do, written as plainly as I can manage.
Why parents ask about probiotics for eczema
The logic is sound, and it is not something people have invented. Researchers have spent thirty years testing it.
The reasoning behind probiotics for eczema
Eczema is an immune condition as much as a skin one. Much of the immune system develops in early life alongside the bacteria that settle in the gut. Therefore, if you could shape those bacteria, you might shape the immune response. It is a genuinely good hypothesis.
Good hypotheses still have to be tested, though. And this one has been, repeatedly, in thousands of children.
What the itch actually costs
Before the evidence, it is worth naming what is at stake, because it is more than skin. A large UK birth cohort followed nearly 14,000 children and found that those with eczema slept almost exactly as many hours as everyone else. The difference was in quality, with around 50 per cent higher odds of disturbed sleep at every age.
Notably, that held even for mild eczema, and even when the eczema was inactive. So when a parent tells me the rash “isn’t that bad” but nobody is sleeping, I take the second half of that sentence seriously.
What the evidence on probiotics for eczema really says
Here is where I have to be a good teacher rather than a good salesperson.
The Cochrane finding, stated plainly
The most rigorous review pooled 39 trials covering 2,599 participants. Its conclusion was blunt: probiotics probably make little or no difference to symptoms rated by patients and parents, and the use of probiotics for treating eczema is currently not evidence-based.
That is not my interpretation. That is the sentence.
What “below the minimum important difference” means
Some trials did find an improvement on the severity scores clinicians use. However, the size matters enormously. The scale most often used runs to 103 points, and researchers have worked out that a family needs roughly a 9-point change before they notice anything at all.
The pooled improvement across those trials was about 4 points. In other words, a real statistical signal that a parent would probably never see. Consequently, an analysis of whether more trials of the same strains would help concluded they may well be futile.
Where probiotics for eczema did show something
I am not telling you to throw the box away, and here is why.
A 2022 Italian trial of 100 young children found more of them reaching that meaningful 9-point improvement, and more days without needing rescue medication. Crucially, the authors described the result as useful adjunctive therapy — an addition to standard care, in a trial where emollients and prescribed treatment continued throughout.
Similarly, a 2024 European task force review of 20 trials found a consistent reduction in severity scores in children without food allergy. So the honest summary is not “useless”. It is “small, inconsistent, and worth something as an add-on rather than a replacement”.
Probiotics for eczema prevention are a different question
This distinction gets collapsed constantly, and collapsing it is how families end up disappointed.
What the prevention trials found
Prevention means giving probiotics to pregnant women, breastfeeding mothers and babies before any eczema exists. That research looks considerably better than the treatment research. Pooled analyses have found meaningfully lower rates of eczema developing, particularly when supplementation covers both pregnancy and the first months of life.
An Australian review from the Royal Children’s Hospital and Murdoch Children’s added a useful detail. Mixtures of strains outperformed single strains, and giving them to mother and baby worked better than either alone.
The trial that failed
Balance matters, so here is the other side. A 2008 German prevention trial randomised women from allergy-prone families and followed their babies to age two. Eczema occurred in 28 per cent of the probiotic group and 27 per cent of the placebo group — no difference whatsoever.
More importantly, recurrent wheezing bronchitis was more common in the probiotic group. That is one trial and not a settled finding, but it is exactly the sort of result that gets quietly left out of supplement marketing.
What the peak body concluded
The World Allergy Organization looked at all of it and landed somewhere careful. They suggest probiotics may be worth considering for high-risk pregnancies and infants, while stating that all their recommendations are conditional and supported by very low quality evidence.
That is a fair summary of the whole field, and I would rather hand it to you than a promise.
Why strain matters when choosing probiotics for eczema
“Probiotic” is not one thing. It is a category, roughly as specific as “medication”.
The most studied strain has the most famous failures
Lactobacillus rhamnosus GG is the strain with the longest research history in eczema, and its record is genuinely split. Three separate trials in infants found no therapeutic effect at all, one of them explicitly reporting no difference in symptoms, steroid use or antihistamine use. Meanwhile, one pooled analysis found the effect for this strain numerically favoured placebo.
Then the 2022 trial mentioned earlier found benefit as an add-on. Both things are true, and that is what mixed evidence actually looks like.
What that means at the pharmacy
A supermarket capsule labelled simply “probiotic” is unlikely to contain what a trial used, at the dose a trial used. If you are going to try one, it is worth choosing deliberately rather than grabbing whichever box is on special. Otherwise you are running an experiment with no idea what you put in it.
Omega-3 for eczema, and how it compares with probiotics
Fish oil is the other bottle parents bring to appointments, usually sitting in the same shopping bag as the probiotics. So it deserves the same treatment as probiotics for eczema: what the reasoning is, and whether the trials have supported it.
The reasoning behind omega-3, and why it is sound
Omega-6 fats feed inflammatory signalling molecules. Omega-3 fats compete for the same enzymes and produce calmer ones. Meanwhile, Western diets have shifted heavily towards omega-6 over the past century, and eczema has become more common across roughly the same period.
Consequently the theory almost writes itself, and it is a better theory than most. Whether the trials have borne it out is a separate question.
What omega-3 does for eczema that is already there
Less than the theory promises. A Cochrane review of dietary supplements in established eczema pooled 11 trials and 596 participants, and concluded there was no convincing evidence of benefit from any of them, fish oil included. Two small fish oil studies did hint at a modest effect. However, the authors were clear that a large registered trial would be needed before practice should change.
The most encouraging single study gave 53 adults 5.4 grams of DHA daily for eight weeks and found a real improvement in eczema severity against a matched control. Still, it was a pilot, it has not been repeated at scale, and 5.4 grams a day is far more than a family-sized fish oil bottle delivers.
A 2022 review of 69 studies of fatty acids, vitamins and minerals in childhood eczema landed in the same place. Overall the evidence is inconclusive, although the balance of omega-3 to omega-6 across the whole diet may play a small part.
Omega-3 in pregnancy, where the evidence splits
Prevention is where omega-3 has its strongest signal, and also its loudest disagreement.
On one side, a 2015 Australian meta-analysis found that higher omega-3 intake in pregnancy reduced atopic eczema in the first twelve months, along with sensitisation to egg and to food generally. In contrast, a 2022 meta-analysis of six trials covering 1,646 mother-infant pairs found no reduction in eczema overall, and only a smaller signal for IgE-associated eczema in children under three.
An earlier meta-analysis found nothing at all. Similarly, the European Academy of Allergy and Clinical Immunology concluded in 2020 that omega-3 in pregnancy does not change the risk of eczema or food allergy, whatever it may do for wheeze.
In other words, this looks a great deal like the probiotics picture. An early promising result, followed by larger and better trials that shrink it.
The trial that tested omega-3 and probiotics for eczema together
Usefully, someone has run the obvious experiment. A Finnish trial randomised 439 women in early pregnancy to fish oil, probiotics, both, or neither, and continued the supplements until six months after birth.
Neither supplement, alone or combined, changed rates of eczema, food allergy or atopy at twelve or twenty-four months. Notably, the probiotic arm did show lower odds of recurrent wheezing at two years, which is interesting and not at all what anyone was looking for.
Therefore, if you are choosing between the two for skin specifically, the honest answer is that neither has earned the confidence it is sold with.
Where that leaves fish on the plate
Somewhere quite different, fortunately. Oily fish two or three times a week is worth eating on its own merits, and no trial has ever been needed to justify sardines. Moreover it costs nothing to try, it carries none of the risks of an elimination diet, and any benefit to the skin is a bonus rather than the reason.
Where a child genuinely will not eat fish, a supplement is reasonable and safe at sensible doses. Simply hold it as nutrition rather than as treatment.
What the evidence supports more strongly than probiotics
If we are following the evidence, honesty requires pointing at the things that outperform the thing you came here to read about.
Moisturisers, unglamorously
A Cochrane review of 77 studies found that using a moisturiser alongside active treatment worked better than active treatment alone. Flares were less frequent, and the time between flares stretched from a median of 30 days to 180. Families also needed noticeably less steroid cream.
Interestingly, the same review found no reliable evidence that one moisturiser beats another. So the expensive one is not necessarily the better one. Frequency matters more than brand.
Where steroid creams sit
I want to be very clear here, because there is a great deal of frightening material online. A 2024 Cochrane network analysis of 291 studies and nearly 46,000 participants found potent topical steroids among the most effective treatments available. It found no evidence of increased skin thinning with short-term use. It also found steroids were the class least likely to cause skin reactions.
A separate five-year trial recorded a single episode of skin atrophy among 1,213 children. Used as prescribed, they are safer than their reputation.
Vitamin D, with caveats
Vitamin D is worth checking, particularly through an Australian winter. Some pooled analyses show modest improvements in severity with supplementation. However, one 2023 analysis found no benefit overall, and specifically none in trials limited to children. Correcting a genuine deficiency is sensible. Supplementing everybody is not.
Food, allergy and the temptation to eliminate
Almost every family I see has already wondered whether something in the diet is causing this. Sometimes it is. Often it is not, and finding out properly matters.
Why testing does not settle it
Skin prick tests and specific IgE blood tests measure sensitisation, which is not the same as allergy. A positive result below the relevant threshold is not a diagnosis, and Australian population data from the HealthNuts study has mapped those thresholds carefully. Test results only mean something read against the child’s actual history.
Furthermore, a 2022 meta-analysis found that elimination guided by testing performed no better than elimination guided by guesswork. That finding surprises people, and it should change how confidently anyone sells a test.
First, do no harm
The first principle of naturopathy is Primum Non Nocere, and nowhere does it apply more directly than here.
That same 2022 review found the benefit of dietary elimination was slight and possibly unimportant, with a confidence interval whose lower bound was zero. Against that sits real, measured harm. In one review of 298 children, 19 per cent developed brand new immediate reactions to foods after starting an elimination diet, and 30 per cent of those reactions were anaphylaxis. Another study of 150 toddlers found significantly lower weight, height and head circumference in those on restricted diets.
So no, I will not hand you a list of foods to remove. A short, supervised trial of one food with a proper reintroduction is a completely different proposition, and that I will happily help with.
What happens when a family comes in about eczema
Mostly it starts with questions rather than answers.
The history first
When did it start, and what else was happening then. What the flares track with — seasons, illness, stress, the pool, a particular week of the month for older girls. What has already been tried, for how long, and what happened when it stopped. Whether anyone is sleeping.
That history usually tells me more than anything I could order.
Obligation-free suggestions
Any nutritional or herbal suggestions are obligation-free, and they sit alongside whatever your GP or dermatologist has prescribed rather than replacing it. Where something needs ruling out, I will refer you through your GP. Some families leave with a supplement plan. Others leave with a bathing routine, a moisturiser they will actually use twice a day, and permission to stop cutting foods out.
When to see your GP or dermatologist
Please see a doctor promptly if the skin is weeping, crusted, painfully sore or looks infected. The same applies if your child is unwell with it, if the eczema is not responding to prescribed treatment, or if sleep loss is affecting the whole family. There are now genuinely effective options beyond topical treatment, and that conversation belongs with a doctor.
Asking for medical help is not a failure of natural medicine. It is what ruling out red flags looks like.
Frequently asked questions about probiotics for eczema
Do probiotics for eczema actually work?
For treating established eczema, the best-quality review of 39 trials found they probably make little or no difference to symptoms as parents rate them. Some individual trials show benefit as an add-on to standard care. So they are not useless, but they are not the answer on their own either.
Which probiotics for eczema are worth trying?
Strain and dose matter more than the word on the front of the box. Multi-strain products have performed better than single strains in the prevention research. If you are going to trial one, it is worth choosing a specific product deliberately rather than picking whatever is discounted.
Can probiotics for eczema replace steroid cream?
No. Nothing in this article replaces a treatment your doctor has prescribed. When skin is inflamed, topical steroids have the strongest evidence behind them, and the research on their safety when used as directed is genuinely reassuring. Supportive care sits alongside them, never instead of them.
Should I take probiotics in pregnancy to prevent eczema?
The prevention evidence is stronger than the treatment evidence, particularly when supplementation spans pregnancy and the early months. Even so, the World Allergy Organization grades its own recommendations as conditional and based on very low quality evidence. It is a reasonable thing to consider and discuss, not a guarantee.
How long should we try probiotics for eczema?
If you are trialling one, give it around 8 to 12 weeks and decide honestly at the end. One analysis found no measurable effect in the first two months at all. Set the date before you start, so the trial ends on evidence rather than on hope.
Is my child’s eczema caused by food?
Sometimes food is a genuine trigger, and more often it is not. Because unnecessary elimination carries real risks to growth and to allergy development, this is worth investigating properly with your GP rather than through trial and error at home.
Should we take omega-3 as well as probiotics for eczema?
You can, and it is safe, but do not expect a great deal from either. The one trial that gave fish oil and probiotics from early pregnancy found that neither prevented eczema. Oily fish in the diet is still worth having, for reasons that have very little to do with skin.
Where to from here
If eczema has been running your household for months, and nobody has yet asked about sleep, the itch-scratch cycle or what has already been tried, that conversation is overdue. You can read more about our approach to skin health, or book an appointment at our Geelong or Drysdale clinic, or by telehealth.
Related reading
- Gut health and skin: what the evidence shows
- Hormonal acne in adult women: naturopathic treatments and the evidence
- Foods that cause eczema in children: how to find out properly
Related: our Babies and Toddlers and Eczema pages explain how we approach these conditions alongside your doctor.
References
Evidence on probiotics for eczema
- Makrgeorgou A, et al. Probiotics for treating eczema. Cochrane Database of Systematic Reviews. 2018. https://doi.org/10.1002/14651858.CD006135.pub3
- Carucci L, et al. Therapeutic effects elicited by the probiotic Lacticaseibacillus rhamnosus GG in children with atopic dermatitis (ProPAD trial). Pediatric Allergy and Immunology. 2022. https://doi.org/10.1111/pai.13836
- Vassilopoulou E, et al. Nutritional and dietary interventions in RCTs for skin symptoms in children with atopic dermatitis: an EAACI Task Force Report. Allergy. 2024. https://doi.org/10.1111/all.16160
- Huang R, et al. Probiotics for the treatment of atopic dermatitis in children. Frontiers in Cellular and Infection Microbiology. 2017. https://doi.org/10.3389/fcimb.2017.00392
- Fölster-Holst R, et al. Prospective, randomized controlled trial on Lactobacillus rhamnosus in infants with moderate to severe atopic dermatitis. British Journal of Dermatology. 2006. https://doi.org/10.1111/j.1365-2133.2006.07558.x
- Grüber C, et al. Randomized, placebo-controlled trial of Lactobacillus rhamnosus GG as treatment of atopic dermatitis in infancy. Allergy. 2007. https://doi.org/10.1111/j.1398-9995.2007.01543.x
- Amalia N, et al. Probiotic supplementation in pregnant mother, breastfeeding mother and infant for the prevention of atopic dermatitis in children. Australasian Journal of Dermatology. 2020. https://doi.org/10.1111/ajd.13186
- Kopp MV, et al. Randomized, double-blind, placebo-controlled trial of probiotics for primary prevention. Pediatrics. 2008. https://doi.org/10.1542/peds.2007-1492
- Fiocchi A, et al. World Allergy Organization–McMaster University Guidelines for Allergic Disease Prevention: Probiotics. World Allergy Organization Journal. 2015. https://doi.org/10.1186/s40413-015-0055-2
Evidence on eczema care, sleep and diet
- Lax SJ, et al. Topical anti-inflammatory treatments for eczema: network meta-analysis. Cochrane Database of Systematic Reviews. 2024. https://doi.org/10.1002/14651858.CD015064.pub2
- Harvey J, et al. The long-term safety of topical corticosteroids in atopic dermatitis: a systematic review. Skin Health and Disease. 2023. https://doi.org/10.1002/ski2.268
- van Zuuren EJ, et al. Emollients and moisturisers for eczema. Cochrane Database of Systematic Reviews. 2017. https://doi.org/10.1002/14651858.CD012119.pub2
- Ramirez FD, et al. Association of atopic dermatitis with sleep quality in children. JAMA Pediatrics. 2019. https://doi.org/10.1001/jamapediatrics.2019.0025
- Oykhman P, et al. Dietary elimination for the treatment of atopic dermatitis: a systematic review and meta-analysis. Journal of Allergy and Clinical Immunology: In Practice. 2022. https://doi.org/10.1016/j.jaip.2022.06.044
- Chang A, et al. Natural history of food-triggered atopic dermatitis and development of immediate reactions in children. Journal of Allergy and Clinical Immunology: In Practice. 2016. https://doi.org/10.1016/j.jaip.2015.08.006
- Low DW, et al. Food restriction, nutrition status, and growth in toddlers with atopic dermatitis. Pediatric Dermatology. 2020. https://doi.org/10.1111/pde.14004
- Peters RL, et al. Natural history of peanut allergy and predictors of resolution in the first 4 years of life. Journal of Allergy and Clinical Immunology. 2015. https://doi.org/10.1016/j.jaci.2015.01.002
- Park JS, et al. Effect of vitamin D on the treatment of atopic dermatitis. Allergy, Asthma and Immunology Research. 2023. https://doi.org/10.4168/aair.2023.15.2.262
Research on omega-3 and probiotics for eczema
- Bath-Hextall FJ, et al. Dietary supplements for established atopic eczema — Cochrane Database of Systematic Reviews. 2012. https://doi.org/10.1002/14651858.CD005205.pub3
- Koch C, et al. Docosahexaenoic acid supplementation in atopic eczema: a randomized, double-blind, controlled trial. British Journal of Dermatology. 2008. https://doi.org/10.1111/j.1365-2133.2007.08430.x
- Labib A, et al. The effect of fatty acids, vitamins, and minerals on pediatric atopic dermatitis: a systematic review. Pediatric Dermatology. 2022. https://doi.org/10.1111/pde.15143
- Best KP, et al. Omega-3 long-chain PUFA intake during pregnancy and allergic disease outcomes in the offspring. American Journal of Clinical Nutrition. 2016. https://doi.org/10.3945/ajcn.115.111104
- Jia Y, et al. Effect of prenatal omega-3 polyunsaturated fatty acid supplementation on childhood eczema. International Archives of Allergy and Immunology. 2022. https://doi.org/10.1159/000526366
- Anandan C, et al. Omega 3 and 6 oils for primary prevention of allergic disease: systematic review and meta-analysis. Allergy. 2009. https://doi.org/10.1111/j.1398-9995.2009.02042.x
- Venter C, et al. Dietary factors during pregnancy and atopic outcomes in childhood: a systematic review from the EAACI. Pediatric Allergy and Immunology. 2020. https://doi.org/10.1111/pai.13303
- Komulainen M, et al. Maternal fish oil and/or probiotics intervention: allergic diseases in children up to two years old. Pediatric Allergy and Immunology. 2023. https://doi.org/10.1111/pai.14004
