An imbalance in the skin microbiome can lead to a variety of skin conditions. Thus the skin microbiome is being widely studied for both therapeutic and cosmetic purposes. Manipulating the human skin microbiome to address skin conditions has opened newer avenues for therapy.

The skin microbiome manipulation strategies may include skin microbiome transplantation, over skin bacteriotherapy, use of prebiotics, probiotics and postbiotics. Altering the skin microbiome by applying live bacteria is recently in focus. Since specific microbial species are associated with particular skin diseases, Bacteria can be easily applied to locally defined areas and can be removed with disinfection or systemic antibiotic treatment in the case of adverse events. Thus they demonstrate easy access and a great safety profile.

Engraftment remains the newer phenomenon, but manipulating the skin microbiome to make the applied bacteria stable on the skin remains challenging. Removing the subcutaneous microbiota despite initial topical disinfection steps remains very difficult. Thus, the applied new microbiota on the skin epidermis tends to compete with those of the deeper skin layers.

Skin conditions are commonly treated with antimicrobial or anti-inflammatory approaches, which may be successful in the short run, but these antimicrobial approaches can ultimately lead to disbalances and an increase in multiresistant strains. 

Most of the research on the skin microbiome focuses on bacteria, which are not the only inhabitants of human skin. They are accompanied by the presence of fungi, phages and micro-eukaryotes, which most likely play a role in normal skin homeostasis. Thus the manipulation of these inhabitants can also prove valuable in addressing skin conditions. But more research is needed in this field.

Source: Callewaert C, Knödlseder N, Karoglan A, Güell M, Paetzold B. Skin microbiome transplantation and manipulation: Current state of the art. Comput Struct Biotechnol J. 2021;19:624-631. Published 2021 Jan 4. doi:10.1016/j.csbj.2021.01.001