Atopic dermatitis (AD) is a long-standing inflammatory skin disease and is highly prevalent worldwide. Numerous factors contribute to AD, with genetics and the environment influencing the disease development. Although AD shows signs of skin barrier defect and immunological deviation, its underlying mechanism is not well understood, and thus the treatment is often challenging. 

Evidence indicates that AD patients have a disturbed microbial composition and lack microbial diversity in their skin and gut compared to controls, contributing to disease onset and the atopic march. It is unclear if a microbial change in AD is due to barrier defects or the cause of barrier dysfunction and inflammation. However, we know about a cross-talk between commensals and the immune system, and their alteration may affect the maturation of innate and adaptive immunity during early life. The novel concept of modifying skin microbiome by applying moisturizers containing nonpathogenic biomass may serve as a preventive and therapeutic option in high-risk groups but currently lacks evidence. 

Another novel approach can be modulating the microbiota through pre-, pro- and symbiotic supplementation to improve the host′s health. Although there is currently little evidence proving probiotics′ effect in preventing/treating AD, it may become an alternative in the future ′post-antibiotic′ era. Normal vaginal delivery, breast milk feeding, supplementation of vitamin D to pregnant women and infants, and restriction of antibiotics in early life may further reduce the AD risk. Precision and personalized medicine with microbiome may become the primary AD treatment in the future.

Source: Kim JE, Kim HS. Microbiome of the skin and gut in atopic dermatitis (AD): understanding the pathophysiology and finding novel management strategies. J Clin Med. 2019;8(4):444.