Management of mild to moderate atopic dermatitis is traditionally focused on controlling inflammation and restoring the skin barrier. To achieve rapid symptom relief, dermatologists frequently prescribe topical corticosteroids. Despite their well-established short-term efficacy, prolonged or extensive use is associated with risks. Skin atrophy, telangiectasia, rosacea, and increased skin surface pH, which predispose to pathogenic colonization, are among the potential consequences. There is also a persistent risk of systemic adverse effects or contact sensitization. All of this underscores the need for gentler, supportive strategies—ideally those that stabilize the barrier and reduce reliance on intensive pharmacologic interventions.

Why collagen?

Accumulating evidence suggests that collagen metabolism is disrupted in atopic dermatitis. Findings from animal models, cell culture studies, and early open-label clinical trials indicate that oral collagen peptides may exert anti-inflammatory effects and support barrier recovery. However, until recently, robust placebo-controlled evidence was lacking.

A German research group has now published the first double-blind randomized trial specifically assessing the effects of bioactive collagen peptides in patients with moderate atopic dermatitis [1].

Study design: what the authors did

The study included 30 adult patients with a confirmed diagnosis and SCORAD (Severity Scoring of Atopic Dermatitis) between 15 and 40. Over 12 weeks, participants were randomly assigned to two groups: one received 5 g of collagen peptides daily, while the other received a placebo.

Importantly, the tested product was a hydrolyzed bovine type I collagen with low-molecular-weight peptides (<2.0 kDa), ensuring high bioavailability.
For ethical reasons, disease control was maintained in both groups. All participants were allowed to use a basic emollient for daily care, and in case of significant inflammation, a “rescue” topical corticosteroid cream (triamcinolone acetonide). Notably, the frequency and total amount of this rescue therapy were key markers of treatment success: the less frequently it was needed, the more effective the primary intervention.

Reduced corticosteroid use and faster itch relief

The findings indicate that dietary collagen helps the skin better cope with the disease.
First, participants in the collagen group used significantly less corticosteroid cream: an average of 0.94 g over 12 weeks versus 5.60 g in the placebo group.

Second, collagen peptides accelerated the relief of pruritus, the most distressing symptom of atopic dermatitis. According to the 5-D Pruritus Scale, itch intensity decreased significantly as early as week 4 in the collagen group, whereas the placebo group reached statistically significant improvement only by week 12.

Safety was also favorable, with no adverse events related to supplementation reported.

Improvement in skin barrier parameters

Objective assessments confirmed patients’ subjective improvements.

Skin surface pH

At baseline, the pH of affected skin was elevated in both groups (5.63 ± 0.45 in the collagen group and 5.69 ± 0.31 in the placebo group), which is typical of atopic dermatitis and reflects impaired barrier integrity.

After 12 weeks, opposite trends were observed:

• In the collagen group, pH stabilized within the physiological range of 4.5–5.5. By the end of the study, affected areas remained within this reference range.
• In the placebo group, skin alkalization progressed, with pH continuing to rise and exceeding the upper limit of normal (reaching approximately 6.0).

Stratum corneum hydration

At baseline, hydration of affected skin was reduced in both groups (25.4 ± 12.4 a.u. in the collagen group and 18.4 ± 9.93 a.u. in the placebo group), reflecting the xerosis typical of atopic dermatitis.

After 12 weeks:

• In the collagen group, stratum corneum hydration increased significantly (p = 0.040; d = 1.07), reaching levels comparable to unaffected skin (no significant difference between affected and unaffected areas: p = 0.207).
• In the placebo group, no significant changes in hydration were observed, and values remained low, maintaining a statistically significant gap compared to healthy skin.

Transepidermal water loss (TEWL)

TEWL decreased in both groups:

• Collagen group: from 27.8 ± 16.8 to 21.9 ± 11.0 g/m²/h.
• Placebo group: from 34.7 ± 18.0 to 23.0 ± 14.6 g/m²/h.

However, mediation analysis showed that the TEWL reduction in the placebo group was largely driven by more frequent use of topical glucocorticosteroids. In contrast, the collagen group demonstrated favorable barrier improvements with minimal reliance on rescue therapy, supporting a direct beneficial effect of the peptides.

Limitations and practical implications

The authors acknowledge limitations, including a small sample size and the allowance of corticosteroid use, which complicated the analysis of the direct clinical effect of collagen peptides. Additionally, the findings apply specifically to the tested collagen hydrolysate formulation.

Nevertheless, from a clinical perspective, these results offer a valuable tool. Oral administration of specific collagen peptides appears to be a promising and safe adjunctive approach for patients with mild to moderate atopic dermatitis. This strategy not only helps reduce pruritus and stabilize the skin’s acid mantle but also significantly lowers the need for corticosteroids. In the long term, it may reduce cumulative skin burden, prolong remission, and improve patients’ quality of life.

References:

1. Proksch E., Schunck M., Zdzieblik D., Oesser S. Oral administration of specific bioactive collagen peptides in the treatment of moderate forms of atopic dermatitis – a new approach. Skin Pharmacol Physiol 2026 Feb 27: 1–24. DOI: 10.1159/000551215.