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




they recommend that skincare products targeting AD should be developed with a focus on maintaining the balance of healthy skin microbiome. Overall, board members were in agreement that maintaining microbial homeostasis is a crucial component of AD therapies. Currently, an AD management program that includes reducing pathogenic organisms, optimizing the re-population of the (healthy diversified) microbiome, and restoring the skin barrier is needed. As the microbiome plays a role in the prevention of AD and also in the active phase of the disease,39,50 a product displaying pre- and post-biotic activity may prove beneficial.

Given the biological properties of LRP-TSW and of the biomass of Vitreoscilla filiformis, its use in a LRP-TSW and APF emollient for treating AD warrants consideration as a new strategy for treating inflammatory skin conditions.52,53 This process combines the beneficial effects of an emollient containing the lysate of nonpathogenic bacteria Vitreoscilla filiformis, to target a significant factor in the pathogenesis of AD. LRP-TSW displays anti-free radical, immunomodulatory, anti-inflammatory properties. It also introduces selenium and strontium to reduce the production of inflammatory cytokines.53 Furthermore, the biomass contained in the LRP-TSW and APF emollient releases lysates that normalize dysbiosis, re-balancing the bacterial content of lesions and nonlesional areas of AD skin.55 Given these findings, investigators approved of the use of this selenium-rich TSW as an active ingredient in topical, irritant-reducing formulations.53 Overall, these findings suggest that a new strategy for managing inflammatory skin diseases may be to combine the use of pre- and post-biotics into a moisturizer. Such a treatment may help restore homeostasis of the skin, re-populate the diversity of the microbiome, encourage the growth of commensal bacteria, and improve barrier function and symptoms of AD.

CONCLUSION

Enhancement of skin microbiome richness and diversity with a combination of LRP-TSW and APF in an emollient base may offer a valuable option for the treatment and maintenance of inflammatory skin diseases. Clinicians should discuss the benefits of such a product in the context of a full AD management program that covers prevention, active treatment, and maintenance. Future Directives Given that AD progresses through various stages of development, the use of a product that is specially formulated to target a particular phase of the disease may warrant further investigation. For example, future investigations may evaluate a LRP-TSW/APF containing moisturizer during the pre-flare period of AD. The moisturizer is approved for application on children as young as 2 weeks.

DISCLOSURES

The authors disclosed receipt of an unrestricted educational grant from La Roche-Posay Dermatological Laboratories, USA, for support with the research of this work. All authors participated in the development, writing, and reviewing the manuscript and disclosed to have no conflict of interest with the content.

Funding: This review was supported by an unrestricted educational grant from La Roche-Posay Dermatological Laboratories, USA.

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