Atopic eczema (AE), an inflammatory disease of the skin, involves genetic, immunological and environmental factors. AE shows skin barrier disruption on multiple, highly interconnected levels as a hallmark: filaggrin mutations, risen skin pH and a microbiome dysbiosis towards Staphylococcus aureus overgrowth are seen along with an abnormal type 2 immune response. 

Extrinsic factors can majorly influence the development of AE. Since AE initiates the atopic march, its prevention and appropriate treatment are crucial. 

Topical treatment or pre- and probiotics are the standard therapy; however, powerful systemic treatment options are also available, which must be employed after thorough endotyping of the individual patient. Thus, novel microbial and immunological biomarkers can be utilized for predicting disease maturation and treatment response. 

Highlights

• Targeting S. aureus or its communication system can greatly influence local AE treatment.
• S. aureus vaccines can help in managing AE.
• Emollients and pre- and probiotics can help in preventing AE and stopping the atopic march.
• Active modulation of the skin barrier (e.g., pH) and the immune system (e.g., Vitamin D3, sport, food) must be investigated.
• Time frame and trigger factors for AE development need further investigation.

Source: Hülpüsch C, Weins AB, Traidl-Hoffmann C, et al. A new era of atopic eczema research: advances and highlights. Allergy. 2021;76(11):3408-21.