J Clin Aesthet Dermatol. 2025;18(10):16.
Dear Editor:
Approximately 20% of children worldwide have pediatric atopic dermatitis (AD).1 New studies emphasize the role of the gut-skin axis in the pathophysiology of AD, indicating that altering the gut microbiota may decrease inflammation and its symptoms. Fecal microbiota transplantation (FMT) has emerged as a promising treatment for AD due to its ability to restore bacterial diversity and boost immunological function. FMT involves transferring stool from a healthy donor into a patient’s gastrointestinal tract.1 Beneficial bacteria are introduced by administering the processed stool through a nasogastric tube or colonoscopy.2 Despite the effectiveness of FMT in treating adult AD, there are currently no published studies on pediatric populations.
Recent studies have demonstrated the benefits of FMT in adult patients with AD. A randomized, placebo-controlled trial of 30 adults with moderate-to-severe AD found that FMT significantly reduced disease severity, showing a substantial improvement in Eczema Area and Severity Index (EASI) scores.3 FMT also shifted immune markers, notably reducing helper T cell Th2 and Th17 responses, TNF-α, and serum IgE. Moreover, FMT altered the abundance of species and functional pathways of the gut microbiota.3
One recent animal study supports FMT’s potential for pediatric AD. In a juvenile mouse model, FMT treatment significantly improved AD symptoms, restoring gut microbiota diversity, reducing IgE levels and mast cell numbers in skin tissue, and decreasing Th2 cytokines (IL-4, IL-5, IL-13). Additionally, FMT modulated immune responses via the PD-L1/PD-1 pathway, promoting immune tolerance.1 These findings suggest that FMT may similarly benefit pediatric AD, where early intervention could positively influence immune pathways and improve outcomes.
One recent case describes a 15-year-old patient with AD who was successfully treated with washed microbiota transplantation, an advanced form of FMT in which fecal samples are further purified.4 The patient showed significant reductions in SCORAD (SCORing Atopic Dermatitis), EASI, NRS (Numerical Rating Scale), and DLQI (Dermatology Life Quality Index) scores after three months of treatment.4 Microbial analysis showed a decrease in Staphylococcus aureus in skin lesions and increased gut microbiota diversity. No adverse events were reported after one year of follow-up, further supporting the potential of FMT as an effective treatment for pediatric AD.4
A single-center retrospective study involving 74 children treated with FMT for various conditions evaluated the long-term safety of the therapy.2 Short-term adverse events occurred in 35.1% of patients, with symptoms such as abdominal pain, bloating, and fever, resolving within 48 hours. Severe adverse events were rare (0.79% of sessions) and included one rotavirus and one urinary tract infection, both of which improved with treatment. Notably, patients with ulcerative colitis experienced a higher rate of adverse events. During follow-up, no autoimmune or metabolic disorders emerged; however, a few children developed conditions such as rhinitis and constipation.2 These findings support FMT’s safety profile as a treatment for pediatric AD.
In conclusion, FMT could serve as a novel treatment for pediatric AD, supported by evidence of its efficacy in adult AD and demonstrated safety in other microbiota-related conditions. Further research is warranted to confirm FMT’s efficacy and establish safety protocols.
With regard,
Leo Wan, BA; Aileen Park, BS; and Peter Lio, MD
Keywords. Eczema, atopic dermatitis, fecal microbiota transplantation, dermatitis, treatment
Affiliations. Mr. Wan is with the West Virginia School of Osteopathic Medicine in Lewisburg, West Virginia. Ms. Park is with the University of Colorado Anschutz School of Medicine in Aurora, Colorado. Dr. Lio is with the Feinberg School of Medicine at Northwestern University in Chicago, Illinois.
Funding. No funding was provided for this article.
Disclosures. The authors declare no conflicts of interest relevant to the content of this article.
References:
- Wang XZ, Huang JL, Zhang J, et al. Fecal microbiota transplantation as a new way for OVA-induced atopic dermatitis of juvenile mice. Int Immunopharmacol. 2024;142(Pt B):113183.
- Zou B, Liu SX, Li XS, et al. Long-term safety and efficacy of fecal microbiota transplantation in 74 children: a single-center retrospective study. Front Pediatr. 2022;10.
- Liu X, Luo Y, Chen X, et al. Fecal microbiota transplantation against moderate-to-severe atopic dermatitis: a randomized, double-blind controlled explorer trial. Allergy. 2025;80(5):1377-1388.
- Deng WY, Chen WJ, Zhong HJ, Wu LH, He XX. Washed microbiota transplantation: a case report of clinical success with skin and gut microbiota improvement in an adolescent boy with atopic dermatitis. Front Immunol. 2023;14:1275427.