Article breakdown

Skin microbiome dysbiosis and the role of Staphylococcus aureus in atopic dermatitis in adults and children: A narrative review.

Journal of the European Academy of Dermatology and Venereology : JEADV • 2023 Jun • Vol 37 Suppl 5, 3-17. PMID 37232427.

This review says atopic dermatitis is closely linked to an imbalanced skin microbiome, especially too much Staphylococcus aureus on the skin during flares. The authors summarize earlier research suggesting that lowering S. aureus and restoring healthier bacterial balance may help control symptoms and reduce flares in both children and adults. They also note that some standard eczema treatments and newer bacteria-targeted approaches may affect the skin microbiome, but this paper is a narrative review rather than one new clinical trial.

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In short

What this paper found

This review says atopic dermatitis is closely linked to an imbalanced skin microbiome, especially too much Staphylococcus aureus on the skin during flares.

The authors summarize earlier research suggesting that lowering S. aureus and restoring healthier bacterial balance may help control symptoms and reduce flares in both children and adults.

They also note that some standard eczema treatments and newer bacteria-targeted approaches may affect the skin microbiome, but this paper is a narrative review rather than one new clinical trial.

Deep dive

What the paper is actually saying

Why This Paper Exists

Atopic dermatitis involves more than dry, inflamed skin. The abstract explains that skin-barrier problems, immune responses, and skin bacteria interact with each other, and that Staphylococcus aureus may play an important role in worsening disease.

What The Authors Wanted To Answer

The authors wanted to summarize recent evidence on how skin microbiome imbalance and S. aureus over-colonization are involved in atopic dermatitis, and what treatments might improve disease by reducing these bacterial changes.

How The Study Was Done

This is a narrative review, meaning it summarizes previously published research rather than reporting a single new experiment. The abstract does not describe a formal systematic search or meta-analysis method.

What The Study Found

According to the reviewed evidence, people with atopic dermatitis often have too much biofilm-forming S. aureus on their skin, especially during flares. This is linked to dysbiosis and lower bacterial diversity, and lower diversity is described as tracking with worse disease severity. The abstract also notes that microbiome changes can appear before visible atopic dermatitis starts in infancy, and that children and adults differ in skin features such as pH, lipids, water activity, and sebum, which relate to the types of microbes present. The review says both indirect treatments, such as emollients plus, anti-inflammatory topical treatments, and monoclonal antibodies, and direct anti-bacterial approaches, such as antiseptics, topical or systemic antibiotics, endolysin, and autologous bacteriotherapy, may help by lowering S. aureus and allowing beneficial commensal bacteria to recover.

Takeaway

The paper’s main message is that managing atopic dermatitis may benefit from paying attention to the skin microbiome, particularly by reducing excess S. aureus while supporting normal commensal bacteria. Because this is a review, it summarizes promising strategies rather than proving that any one approach works best.

Limits

What this abstract does not fully answer

This is a narrative review, so it summarizes earlier studies rather than testing one new treatment in one new experiment.

The abstract does not describe a systematic search strategy, study selection process, or pooled statistical analysis.

The abstract says some therapies 'may' help, which suggests the evidence summarized is not presented as definitive proof of benefit or of the best approach.

Key numbers

Numbers the abstract makes important

This abstract did not highlight a small set of decision-relevant numbers.

Source abstract

Original abstract sections

Abstract

A dysfunctional epidermal barrier, which may be associated with mutations in the filaggrin gene in genetically predisposed individuals or harmful effects of environmental agents and allergens, contributes to the development of atopic dermatitis (AD) due to an interplay between the epithelial barrier, immune defence and the cutaneous microbiome. The skin of patients with AD is frequently over-colonized by biofilm-growing Staphylococcus aureus, especially during flares, causing dysbiosis of the cutaneous microbiota and a decrease in bacterial diversity that inversely correlates with AD severity. Specific changes in the skin microbiome can be present before clinical AD onset in infancy. Additionally, local skin anatomy, lipid content, pH, water activity and sebum secretion differ between children and adults and generally correlate with the predominant microbiota. Considering the importance of S. aureus in AD, treatments aimed at reducing over-colonization to rebalance microbial diversity may help manage AD and reduce flares. Anti-staphylococcal interventions in AD will contribute to a decrease in S. aureus superantigens and proteases that cause damage and inflammation of the skin barrier while concomitantly increasing the proportion of commensal bacteria that secrete antimicrobial molecules that protect healthy skin from invading pathogens. This review summarizes the latest data on targeting skin microbiome dysbiosis and S. aureus over-colonization to treat AD in adults and children. Indirect AD therapies, including emollients 'plus', anti-inflammatory topicals and monoclonal antibodies, may have an impact on S. aureus and help control bacterial diversity. Direct therapies, including antibacterial treatments (antiseptics/topical or systemic antibiotics), and innovative treatments specifically targeting S. aureus (e.g. anti-S. aureus endolysin, and autologous bacteriotherapy), may be effective alternatives to mitigate against an increase in microbial resistance and allow a proportionate increase in the commensal microbiota.