Role of the skin microbiome in atopic dermatitis.

Alexander Salava,Antti Lauerma

doi:10.1186/2045-7022-4-33

Abstract

Atopic dermatitis (AD) is a common inflammatory skin disorder and characterized by abnormalities in both skin barrier structures and alternations of the immune response. Molecular genetics have dramatically changed our vision of the micro-organisms colonizing the human skin and recently well-documented changes in the skin microbiome in atopic dermatitis have become evident. The microbiome shifts have been primarily documented during disease flares and localized to sites of disease predilection, e.g. folds or facial area. In contrast, active treatment has been associated with a recolonisation and higher cutaneous microbial diversity. Additionally to the known dysfunctions in barrier function of the skin (e.g. filaggrin mutations) and immunologic disturbances (e.g. Th2-shift), evidence is rising that atopic dermatitis is also connected to a dysbiosis of the microbial community without an invading pathogen. In the future the investigation of the patient’s skin microbiome may have a foothold in the clinician’s diagnostic repertoire and treatment of atopic dermatitis.

Highlights

The skin microbiome Human skin can be considered as a complex ecosystem
In one study intermittent-treatment flare patients who used sporadic treatments in the week preceding flare sampling, there was an early shift toward a diverse microbiome in the presence of active clinical disease suggesting that known effective treatments in atopic dermatitis diversify the skin bacterial community [15] (Figures 3 and 4)
Atopic dermatitis often occurs in characteristic areas of the skin such as the elbows and knee folds, which could be partly explained by differences in the skin microbiome. Whether these specificities are driven by the endogenous microbial community structure or is only an epiphenomenon due to secondary changes, e.g. changes in the skin barrier in atopic dermatitis or immunologic factors (e.g. Th2-shift), remains to be determined

Summary

Introduction

The skin microbiome Human skin can be considered as a complex ecosystem. An area of approximately 2.0 square meters can accommodate a great variety of habitats ranging from wet skin in the axillary folds to drier areas of the shins. For the protection from pathogenic organisms the commensal microbial flora receives as a compensation an area of skin to colonize and ecological niche in the host [2]. A very interesting area for future research will be the development and eventual establishment of the cutaneous microbial diversity during the first years of life and possible connections to skin diseases like atopic dermatitis [7].

Results

Conclusion