Skin microbiome transplantation and manipulation: Current state of the art.

Bernhard Paetzold,Marc Güell,Ante Karoglan,Nastassia Knödlseder,Chris Callewaert

doi:10.1016/j.csbj.2021.01.001

Abstract

Many skin conditions are associated with an imbalance in the skin microbiome. In recent years, the skin microbiome has become a hot topic, for both therapeutic and cosmetic purposes. The possibility of manipulating the human skin microbiome to address skin conditions has opened exciting new paths for therapy. Here we review the skin microbiome manipulation strategies, ranging from skin microbiome transplantation, over skin bacteriotherapy to the use of prebiotics, probiotics and postbiotics. We summarize all efforts undertaken to exchange, manipulate, transplant or selectively apply the skin microbiome to date. Multiple microbial groups have been targeted, since they have been proven to be beneficial for skin health. We focus on the most common skin disorders and their associated skin microbiome dysbiosis and we review the existing scientific data and clinical trials undertaken to combat these skin conditions. The skin microbiome represents a novel platform for therapy. Transplantation of a complete microbiome or application of single strains has demonstrated beneficial therapeutic application.

Highlights

The understanding of humans as hosts for trillions of microorganisms has changed the way we understand and target diseases
As the microbiome differs topographically, dysbiosis of skin occurs topographically on specific skin sites in a manner similar to that noted in atopic dermatitis, rosacea, acne vulgaris and psoriasis [45,46,47]
For method 1, highly concentrated bacteria can be applied; a higher efficacy can be obtained compared to a complete skin microbiome transplant

Summary

Introduction

The understanding of humans as hosts for trillions of microorganisms has changed the way we understand and target diseases. The Western diet, which is rich in fat and carbohydrates and low in fibre, has altered the gut microbiome, which can lead to an impaired mucus layer and, in further stages, an impaired intestinal barrier. This contributes to an inflammatory state in the body that can be expressed as a skin pathology [17]. It is technically challenging to manipulate or sample locally in the gut, but the skin represents an accessible organ for such studies It is a prime environment for manipulation of the microbiome

The skin microbiome

Dysbiosis of skin

Skin microbiome manipulation strategies

Human skin microbiome manipulation efforts

Application of non-commensal bacteria on skin

Genetically modified bacteria as topical therapeutics

Application of Lactobacillus and other gut probiotics on skin

Discussion and outlook