Efficacy of Probiotics in Dermatitis Herpetiformis Management: An Umbrella Review

Waleed Khalid Alghuyaythat ^1,2* Fawziah Salman Alfaifi ³ Hind Bader S Alshalhoob ² Rana Khalid A Abanumay ² Rayan Hussain A Asiree ² Haya Sulaiman Alnumayr ⁴ Anwar Ghudair T Alanazi ² Maryam Mohammed Alluli ²

• ¹ Majmaah University, Al Majma'ah, Saudi Arabia
• ² College of Medicine, Majmaah University, 11952, Majmaah, Saudi Arabia, Majmaah, Saudi Arabia
• ³ Department of Dermatology, King Faisal Medical City for Southern Region (KFMC), Abha, Saudi Arabia, Abha, Saudi Arabia
• ⁴ College of Medicine, Qassim University, Qassim, Saudi Arabia

Background-The available evidence on probiotics in Dermatitis Herpetiformis (DH) remains severely limited. Given the shared pathophysiology of DH and Coeliac disease (CD), we aimed to provide the hypothesis to synthesize the narrative reviews carried out so far on the use of probiotics in the treatment of DH, its impact on gut microbiota dysbiosis, and the gut-skin axis.Methods: Relevant narrative reviews were searched for in electronic databases such as PubMed, Scopus, Cochrane Library, Embase, and Google Scholar.Results: All 7 included reviews commented on gut microbiota dysbiosis as a common feature in patients with CD and DH. Immune modulation, attenuation of intestinal permeability, and anti-inflammatory effects were some of the postulated effects of probiotics. Probiotics could modulate the gut-skin axis and may prove therapeutic for DH; however, most of the evidence was indirect, drawn from models of CD or theoretically derived.While probiotics showed promise for managing gut dysbiosis and immune regulation in DH, the existing evidence remains speculative. Our results suggest that probiotics could be a useful adjunct to gluten-free dieting in DH treatment, but future studies are needed to support this finding.