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

16. Silverberg JI, Hanifin J, Simpson EL. Climatic factors are associated with childhood eczema prevalence in the United States. J Invest Dermatol. 2013;133(7):1752-1759.
17. Shaw TE, Currie GP, Koudelka CW, Simpson EL. Eczema prevalence in the United States: data from the 2003 National Survey of Children's Health. J Invest Dermatol. 2011;131(1):67-73.
18. Deckers IAG, McLean S, Linssen S, Mommers M, van Schayck CP, Sheikh A. Investigating international time trends in the incidence and prevalence of atopic eczema 1990-2010: a systematic review of epidemiological studies. PLoS One. 2012;7(7):e39803-e39803.
19. Wallach D, Taïeb A. Atopic dermatitis/atopic eczema. Chem Immunol Allergy. 2014;100:81-96.
20. Vijayanand P, Seumois G, Simpson LJ, et al. Interleukin-4 production by follicular helper T cells requires the conserved Il4 enhancer hypersensitivity site V. Immunity. 2012;36(2):175-187.
21. Taïeb A. Hypothesis: from epidermal barrier dysfunction to atopic disorders. Contact Dermatitis. 1999;41(4):177-180.
22. Elias PM, Wood LC, Feingold KR. Epidermal pathogenesis of inflammatory dermatoses. Am J Contact Dermat. 1999;10(3):119-126.
23. Rerknimitr P, Otsuka A, Nakashima C, Kabashima K. Skin Barrier Function and Atopic Dermatitis. Current Dermatology Reports. 2018;7.
24. Kim D, Lee NR, Park S-Y, et al. As in atopic dermatitis, nonlesional skin in allergic contact dermatitis displays abnormalities in barrier function and ceramide content. J Invest Dermatol. 2017;137(3):748-750.
25. Kapur S, Watson W, Carr S. Atopic dermatitis. Allergy Asthma Clin Immunol. 2018;14(Suppl 2):52-52.
26. Proksch E, Fölster-Holst R, Jensen J-M. Skin barrier function, epidermal proliferation and differentiation in eczema. J Dermatol Sci. 2006;43(3):159-169.
27. Weidinger S, Beck LA, Bieber T, Kabashima K, Irvine AD. Atopic dermatitis. Nat Rev Dis Primers. 2018;4(1):1-1.
28. Suárez-Fariñas M, Tintle SJ, Shemer A, et al. Nonlesional atopic dermatitis skin is characterized by broad terminal differentiation defects and variable immune abnormalities. J Allergy Clin Immunol. 2011;127(4):954-964.e644.
29. Baldwin HE, Bhatia ND, Friedman A, Eng RM, Seite S. The role of cutaneous microbiota harmony in maintaining a functional skin barrier. J Drugs Dermatol. 2017;16(1):12-18.
30. Weyrich LS, Dixit S, Farrer AG, Cooper AJ, Cooper AJ. The skin microbiome: Associations between altered microbial communities and disease. Australas J Dermatol. 2015;56(4):268-274.
31. Grice EA, Kong HH, Conlan S, et al. Topographical and temporal diversity of the human skin microbiome. Science. 2009;324(5931):1190-1192.
32. Zapata HJ, Quagliarello VJ. The microbiota and microbiome in aging: potential implications in health and age-related diseases. J Am Geriatr Soc. 2015;63(4):776-781.
33. Costello EK, Lauber CL, Hamady M, Fierer N, Gordon JI, Knight R. Bacterial community variation in human body habitats across space and time. Science. 2009;326(5960):1694-1697.
34. Kong HH, Oh J, Deming C, et al. Temporal shifts in the skin microbiome associated with disease flares and treatment in children with atopic dermatitis. Genome Res. 2012;22(5):850-859.
35. Valdman-Grinshpoun Y, Ben-Amitai D, Zvulunov A. Barrier-restoring therapies in atopic dermatitis: current approaches and future perspectives. Dermatol Res Pract. 2012;2012:923134-923134.
36. Carr WW. Topical calcineurin inhibitors for atopic dermatitis: review and treatment recommendations. Paediatr Drugs. 2013;15(4):303-310.
37. Stuetz A, Baumann K, Grassberger M, Wolff K, Meingassner JG. Discovery of topical calcineurin inhibitors and pharmacological profile of pimecrolimus. Int Arch Allergy Immunol. 2006;141(3):199-212.
38. Paller AS, Tom WL, Lebwohl MG, et al. Efficacy and safety of crisaborole ointment, a novel, nonsteroidal phosphodiesterase 4 (PDE4) inhibitor for the topical treatment of atopic dermatitis (AD) in children and adults. J Am Acad Dermatol. 2016;75(3):494-503.e496.
39. Ahmed A, Solman L, Williams HC. Magnitude of benefit for topical crisaborole in the treatment of atopic dermatitis in children and adults does not look promising: a critical appraisal. Br J Dermatol. 2018;178(3):659-662.
40. Sugarman JL. The epidermal barrier in atopic dermatitis. Semin Cutan Med Surg. 2008;27(2):108-114.
41. Coman O, Ungureanu A-M, Coman L. Atopic dermatitis and skin microbiome - new therapeutic approaches. Rom J Clin Exp Dermatol. 2015;2:1.
42. Lee J-H, Choi CS, Bae I-H, Choi JK, Park Y-H, Park M. A novel, topical, nonsteroidal, TRPV1 antagonist, PAC-14028 cream improves skin barrier function and exerts anti-inflammatory action through modulating epidermal differentiation markers and suppressing Th2 cytokines in atopic dermatitis. J Dermatol Sci. 2018:S0923-1811(0918)30204-30204.
43. Hon KL, Leung AKC, Barankin B. Barrier repair therapy in atopic dermatitis: an overview. Am J Clin Dermatol. 2013;14(5):389-399.
44. Panduru M, Panduru NM, Sălăvăstru CM, Tiplica GS. Probiotics and primary prevention of atopic dermatitis: a meta-analysis of randomized controlled studies. J Eur Acad Dermatol Venereol. 2015;29(2):232-242.
45. Kim S-O, Ah Y-M, Yu YM, Choi KH, Shin W-G, Lee J-Y. Effects of probiotics for the treatment of atopic dermatitis: a meta-analysis of randomized controlled trials. Ann Allergy Asthma Immunol. 2014;113(2):217-226.
46. Wang IJ, Wang JY. Children with atopic dermatitis show clinical improvement after Lactobacillus exposure. Clin Exp Allergy. 2015;45(4):779-787.
47. Drago L, De Vecchi E, Toscano M, Vassena C, Altomare G, Pigatto P. Treatment of atopic dermatitis eczema with a high concentration of Lactobacillus salivarius LS01 associated with an innovative gelling complex: a pilot study on adults. J Clin Gastroenterol. 2014;48 Suppl 1:S47-S51.
48. Niccoli AA, Artesi AL, Candio F, et al. Preliminary results on clinical effects of probiotic Lactobacillus salivarius LS01 in children affected by atopic dermatitis. J Clin Gastroenterol. 2014;48 Suppl 1:S34-S36.
49. Volz T, Skabytska Y, Guenova E, et al. Nonpathogenic bacteria alleviating atopic dermatitis inflammation induce IL-10-producing dendritic cells and regulatory Tr1 cells. J Invest Dermatol. 2014;134(1):96-104.
50. Mahe YF, Perez M-J, Tacheau C, et al. A new Vitreoscilla filiformis extract grown on spa water-enriched medium activates endogenous cutaneous antioxidant and antimicrobial defenses through a potential Toll-like receptor 2/protein kinase C, zeta transduction pathway. Clin Cosmet Investig Dermatol. 2013;6:191-196.
51. Gueniche A, Knaudt B, Schuck E, et al. Effects of nonpathogenic gramnegative bacterium Vitreoscilla filiformis lysate on atopic dermatitis: a prospective, randomized, double-blind, placebo-controlled clinical study. Br J Dermatol. 2008;159(6):1357-1363.
52. van Tubergen A, van der Linden S. A brief history of spa therapy. Ann Rheum Dis. 2002;61(3):273-275.
53. Seite S. Thermal waters as cosmeceuticals: La Roche-Posay thermal spring water example. Clin Cosmet Investig Dermatol. 2013;6:23-28.
54. Seite S, Flores GE, Henley JB, et al. Microbiome of affected and unaffected skin of patients with atopic dermatitis before and after emollient treatment. J Drugs Dermatol. 2014;13(11):1365-1372.
55. Seité S, Zelenkova H, Martin R. Clinical efficacy of emollients in atopic dermatitis patients - relationship with the skin microbiota modification. Clin Cosmet Investig Dermatol. 2017;10:25-33.
56. Guttman-Yassky E, Dhingra N, Leung DYM. New era of biologic therapeutics in atopic dermatitis. Expert Opin Biol Ther. 2013;13(4):549-561.


Anneke Andriessen PhD