Atopic Dermatitis and the Role of the Skin Microbiome in Choosing Prevention, Treatment, and Maintenance Options

October 2020 | Volume 19 | Issue 10 | Original Article | 935 | Copyright © October 2020


Published online October 2, 2020

Hilary Baldwin MDa, Crystal Aguh MDb, Anneke Andriessen PhDc, Latanya Benjamin MD FAAP FAADd, Aaron S. Ferberg MDe, Deirdre Hooper MD FAADf, Joseph L. Jarizzo MDg, Peter A. Lio MDh, Brook Tlougan MD FAADI, Heather C. Woolery-Lloyd MDj, Joshua Zeichner MD FAADk

aAcne Treatment and Research Center, Brooklyn, NY bEthnic Skin Program, Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD cRadboud University Medical Center, Nijmegen, The Netherlands; Andriessen Consultants, Malden, The Netherlands dFlorida Atlantic University, Boca Raton, FL eArkansas Dermatology Skin Cancer Center, Arkansas Research Trials, Little Rock, AR; Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY fAudubon Dermatology; Tulane and Louisiana State Universities, New Orleans, LA gWake Forest School of Medicine and Weill Cornell Medical College, Winston Salem, NC, and New York, NY hDepartment of Dermatology, Feinberg School of Medicine, Northwestern University; Medical Dermatology Associates of Chicago, Chicago, IL iWestmed Medical Group, Purchase, NY; Columbia University Irving Medical Center, Manhattan, New York, NY jFrost Department of Dermatology and Cutaneous Surgery, Miller University of Miami School of Medicine, Miami, FL kDepartment of Dermatology, Mount Sinai Hospital, New York, NY; Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY

Abstract
Background: Atopic dermatitis (AD) is a common skin condition characterized by disturbed barrier function, skin inflammation, and cutaneous dysbiosis. Clinically, it manifests as chronic-recurrent xerosis, pruritus, and erythematous lesions. Its pathophysiology is complex, making the selection of appropriate treatment options a task.
Aim: To share insights gained from a literature review and discussions with experts in dermatology on key factors related to the prevention, treatment, and management of AD in relation to the skin microbiome.
Methods: Results from an expert panel were summarized and discussed to provide updated recommendations for the treatment and maintenance of AD.
Results: Evidence supports a strategy for managing inflammatory skin diseases with a selenium-rich post-biotic thermal water and biomass containing moisturizer. The moisturizer helps to restore homeostasis of the skin, re-populate a diverse microbiome, encourage the growth of commensal bacteria, and improve barrier function and symptoms of AD.
Conclusions: Normalization of skin microbiome diversity using a topical moisturizer containing post-biotic aqua and biomass may offer a valuable option for the treatment and maintenance of inflammatory skin diseases. Clinicians should discuss the benefits of this treatment in the context of a full AD management program that covers prevention, active treatment, and maintenance.

J Drugs Dermatol. 2020;19(10):935-940. doi:10.36849/JDD.2020.5393

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INTRODUCTION

Atopic Dermatitis
Atopic dermatitis (AD) is a common inflammatory skin condition characterized by chronic-recurrent xerosis, pruritus, and erythematous lesions.1 In industrialized countries, the prevalence of AD has been rising since the 1940s; and it is now one of the most frequent chronic inflammatory skin disorders in the world.2,3 With a reported prevalence of over 20% in children and up to 8% in adults,1,4-7 over 92 million people in the United States (U.S.) alone suffer from AD. As there are no objective diagnostic tests for AD,1 diagnosis is made clinically based on the presence of one or more symptoms, which often include: pruritus, erythema, scaling, xerosis, edema, excoriations, oozing, crusting or lichenification.2,5 Although AD can affect any area of the body, the typical anatomical locations of flare-ups (defined as acute, clinically significant worsening of the signs and symptoms of AD)8 depend on age, and patterns change between infancy, childhood, and adulthood.9 For example, in