role that EBD and dysbiosis may play in AV and rosacea, and how best to select prescription and OTC agents to address these deficiencies.
Currently, there are limited clinical studies investigating the use of adjunctive skincare products, especially in AV and rosacea.
Studies investigating the role of pro-/pre-/postbiotics have traditionally focused on AD (and psoriasis).
Future studies, and specifically clinical trials, should assess the implementation of skincare products in AV and rosacea, with particular attention afforded to pro-/pre-/postbiotics and how they may complement current prescription regimens to longitudinally augment clinical improvement and minimize adverse effects and local skin irritation.
Currently, there are limited clinical studies investigating the use of adjunctive skincare products, especially in AV and rosacea.
Studies investigating the role of pro-/pre-/postbiotics have traditionally focused on AD (and psoriasis).
Future studies, and specifically clinical trials, should assess the implementation of skincare products in AV and rosacea, with particular attention afforded to pro-/pre-/postbiotics and how they may complement current prescription regimens to longitudinally augment clinical improvement and minimize adverse effects and local skin irritation.
CONCLUSION
AV and rosacea are multifaceted inflammatory dermatoses
that both have varying degrees of intrinsic EBD, which may be
affected by selected therapy. Similarly, AV and rosacea have
unique CM abnormalities that can be further perturbed by
indiscriminate use of systemic broad-spectrum antibiotics. The
interplay between EBF and the CM is critical for the research and
development of new therapies and methods to approach these
diseases. Appropriately developed prescription and OTC agents
have the potential to selectively influence the microbiome
in a beneficial direction and maintain, if not restore, EBF. By
understanding this intricate interplay, dermatologists will
be better able to educate their patients on the importance of
appropriate skin care and potentially improve their quality of life.
DISCLOSURES
Funding sources: The review was supported by an unrestricted educational grant from La Roche-Posay Dermatological Laboratories, USA.
Conflicts of Interest: The authors disclose receipt from La Roche- Posay Dermatological Laboratories, USA of an unrestricted educational grant for support of the research and work presented here. All authors participated in the development, writing, and reviewing the manuscript. JWM has served as an advisory board member for La Roche-Posay. NB is an advisor and consultant for La Roche-Posay. EG serves as a consultant/ advisor to La Roche-Posay, Lipidor AB. JH serves as an advisor and speaker for LaRoche-Posay and CeraVe. PL reports research grants/funding from AOBiome; is on the speaker's bureau for Galderma, and L'Oreal; reports consulting/advisory boards for L'Oreal, Pierre-Fabre, Johnson & Johnson, Unilever, Theraplex, AOBiome, Galderma, Arbonne, Amyris, Burt's Bees. PL has a patent pending for a Theraplex product with royalties paid and is a Board member of the National Eczema Association. BT and DN have no relevant disclosures or conflicts of interest. HEB serves as an advisor for Galderma, La Roche-Posay, Johnson & Johnson.
Conflicts of Interest: The authors disclose receipt from La Roche- Posay Dermatological Laboratories, USA of an unrestricted educational grant for support of the research and work presented here. All authors participated in the development, writing, and reviewing the manuscript. JWM has served as an advisory board member for La Roche-Posay. NB is an advisor and consultant for La Roche-Posay. EG serves as a consultant/ advisor to La Roche-Posay, Lipidor AB. JH serves as an advisor and speaker for LaRoche-Posay and CeraVe. PL reports research grants/funding from AOBiome; is on the speaker's bureau for Galderma, and L'Oreal; reports consulting/advisory boards for L'Oreal, Pierre-Fabre, Johnson & Johnson, Unilever, Theraplex, AOBiome, Galderma, Arbonne, Amyris, Burt's Bees. PL has a patent pending for a Theraplex product with royalties paid and is a Board member of the National Eczema Association. BT and DN have no relevant disclosures or conflicts of interest. HEB serves as an advisor for Galderma, La Roche-Posay, Johnson & Johnson.
REFERENCES
1. Foster KR, Schluter J, Coyte KZ, Rakoff-Nahoum S. The evolution of the host microbiome as an ecosystem on a leash. Nature. 2017;548(7665):43-51. doi:10.1038/nature23292. PMID: 28770836; PMCID: PMC5749636.
2. NIH HMP Working Group, Peterson J, Garges S, et al. The NIH human microbiome project. Genome Res. 2009;19(12):2317-2323. doi:10.1101/ gr.096651.109
3. Prescott SL, Larcombe DL, Logan AC, et al. The skin microbiome: impact of modern environments on skin ecology, barrier integrity, and systemic immune programming. World Allergy Organ J. 2017;10(1):29. doi:10.1186/s40413-017- 0160-5
4. Kinross JM, Darzi AW, Nicholson JK. Gut microbiome-host interactions in health and disease. Genome Med. 2011;3(3):14. doi:10.1186/gm228
5. Lee YB, Byun EJ, Kim HS. Potential role of the microbiome in acne: a comprehensive review. J Clin Med. 2019;8(7):987. doi:10.3390/jcm8070987
6. Wilson M. The Human Microbiota in Health And Disease: An Ecological And Community-Based Approach. Boca Raton: Garland Science. 2018.
7. Cogen AL, Nizet V, Gallo RL. Skin microbiota: a source of disease or defence? Br J Dermatol. 2008;158(3):442-455. doi:10.1111/j.1365-2133.2008.08437.x
8. Sanford JA, Gallo RL. Functions of the skin microbiota in health and disease. Semin Immunol. 2013;25(5):370-377. doi:10.1016/j.smim.2013.09.005
9. Gallo RL, Nakatsuji T. Microbial symbiosis with the innate immune defense system of the skin. J Invest Dermatol. 2011;131(10):1974-1980. doi:10.1038/ jid.2011.182
10. Wiesner J, Vilcinskas A. Antimicrobial peptides: the ancient arm of the human immune system. Virulence. 2010;1(5):440-464. doi:10.4161/viru.1.5.12983
11. Strugar TL, Kuo A, Seité S, et al. Connecting the dots: from skin barrier dysfunction to allergic sensitization, and the role of moisturizers in repairing the skin barrier. J Drugs Dermatol. 2019;18(6):581.
12. Baldwin HE, Bhatia ND, Friedman A, et al. The role of cutaneous microbiota harmony in maintaining a functional skin barrier. J Drugs Dermatol. 2017;16(1):12- 18.
13. Baldwin H, Aguh C, Andriessen A, et al. Atopic dermatitis and the role of the skin microbiome in choosing prevention, treatment, and maintenance options. J Drugs Dermatol. 2020;19(10):935-940. doi:10.36849/JDD.2020.10.36849/ JDD.2020.5393
14. Barnard E, Shi B, Kang D, et al. The balance of metagenomic elements shapes the skin microbiome in acne and health. [published correction appears in Sci Rep. 2020 Apr 2;10(1):6037]. Sci Rep. 2016;6:39491. doi:10.1038/srep39491
15. Naik S, Bouladoux N, Wilhelm C, et al. Compartmentalized control of skin immunity by resident commensals. Science. 2012;337(6098):1115-1119. doi:10.1126/science.1225152
16. Rocha MA, Bagatin E. Skin barrier and microbiome in acne. Arch Dermatol Res. 2018;310(3):181-185. doi:10.1007/s00403-017-1795-3
17. Misery L, Loser K, Ständer S. Sensitive skin. J Eur Acad Dermatol Venereol. 2016;30(Suppl 1):2-8. doi:10.1111/jdvs13532
18. Thiboutot D, Del Rosso JQ. Acne vulgaris and the epidermal barrier: is acne vulgaris associated with inherent epidermal abnormalities that cause impairment of barrier functions? Do any topical acne therapies alter the structural and/or functional integrity of the epidermal barrier? J Clin Aesthet Dermatol. 2013;6(2):18-24.
19. Tan J, Alexis A, Baldwin H, et al. The personalised acne care pathwayrecommendations to guide longitudinal management from the personalising acne: consensus of experts. JAAD Int. 2021;5:101-111. doi:10.1016/j. jdin.2021.09.006
20. Chularojanamontri L, Tuchinda P, Kulthanan K, Pongparit K. Moisturizers for acne: what are their constituents? J Clin Aesthet Dermatol. 2014;7(5):36-44.
21. Alexis AF, Woolery-Lloyd H, Williams K, et al. Racial/ethnic variations in acne: implications for treatment and skin care recommendations for acne patients with skin of color. J Drugs Dermatol. 2021;20(7):716-725. doi:10.36849/JDD.6169
22. Yamamoto A, Takenouchi K, Ito M. Impaired water barrier function in acne vulgaris. Arch Dermatol Res. 1995;287(2):214-218. doi:10.1007/BF01262335
23. Pappas A, Kendall AC, Brownbridge LC, et al. Seasonal changes in epidermal ceramides are linked to impaired barrier function in acne patients. Exp Dermatol. 2018;27(8):833-836. doi:10.1111/exd.13499
24. Meyer K, Pappas A, Dunn K, et al. Evaluation of seasonal changes in facial skin with and without acne. J Drugs Dermatol. 2015;14(6):593-601.
25. Pappas, A., Dunn, K., Cula, G.O., et al. Barrier and microbiome changes in the facial skin of children as they approach puberty. Presented at: 26th European Academy of Dermatology and Venerology(EADV) Congress: P006513-17 September 2017
26. Borodzicz S, Rudnicka L, Mirowska-Guzel D, Cudnoch-Jedrzejewska A. The role of epidermal sphingolipids in dermatologic diseases. Lipids Health Dis. 2016;15:13. doi:10.1186/s12944-016-0178-7
27. Dréno B, Pécastaings S, Corvec S, et al. Cutibacterium acnes(propionibacterium acnes) and acne vulgaris: a brief look at the latest updates. J Eur Acad Dermatol Venereol. 2018;32(Suppl 2):5-14. doi:10.1111/jdvs15043
28. Dreno B, Martin R, Moyal D, et al. Skin microbiome and acne vulgaris: staphylococcus, a new actor in acne. Exp Dermatol. 2017;26(9):798-803. doi:10.1111/exd.13296
29. Fitz-Gibbon S, Tomida S, Chiu BH, et al. Propionibacterium acnes strain populations in the human skin microbiome associated with acne. J Invest Dermatol. 2013;133(9):2152-2160. doi:10.1038/jid.2013.21
30. Gollnick H. Current concepts of the pathogenesis of acne: implications for drug treatment. Drugs. 2003;63(15):1579-1596. doi:10.2165/00003495-200363150- 00005
2. NIH HMP Working Group, Peterson J, Garges S, et al. The NIH human microbiome project. Genome Res. 2009;19(12):2317-2323. doi:10.1101/ gr.096651.109
3. Prescott SL, Larcombe DL, Logan AC, et al. The skin microbiome: impact of modern environments on skin ecology, barrier integrity, and systemic immune programming. World Allergy Organ J. 2017;10(1):29. doi:10.1186/s40413-017- 0160-5
4. Kinross JM, Darzi AW, Nicholson JK. Gut microbiome-host interactions in health and disease. Genome Med. 2011;3(3):14. doi:10.1186/gm228
5. Lee YB, Byun EJ, Kim HS. Potential role of the microbiome in acne: a comprehensive review. J Clin Med. 2019;8(7):987. doi:10.3390/jcm8070987
6. Wilson M. The Human Microbiota in Health And Disease: An Ecological And Community-Based Approach. Boca Raton: Garland Science. 2018.
7. Cogen AL, Nizet V, Gallo RL. Skin microbiota: a source of disease or defence? Br J Dermatol. 2008;158(3):442-455. doi:10.1111/j.1365-2133.2008.08437.x
8. Sanford JA, Gallo RL. Functions of the skin microbiota in health and disease. Semin Immunol. 2013;25(5):370-377. doi:10.1016/j.smim.2013.09.005
9. Gallo RL, Nakatsuji T. Microbial symbiosis with the innate immune defense system of the skin. J Invest Dermatol. 2011;131(10):1974-1980. doi:10.1038/ jid.2011.182
10. Wiesner J, Vilcinskas A. Antimicrobial peptides: the ancient arm of the human immune system. Virulence. 2010;1(5):440-464. doi:10.4161/viru.1.5.12983
11. Strugar TL, Kuo A, Seité S, et al. Connecting the dots: from skin barrier dysfunction to allergic sensitization, and the role of moisturizers in repairing the skin barrier. J Drugs Dermatol. 2019;18(6):581.
12. Baldwin HE, Bhatia ND, Friedman A, et al. The role of cutaneous microbiota harmony in maintaining a functional skin barrier. J Drugs Dermatol. 2017;16(1):12- 18.
13. Baldwin H, Aguh C, Andriessen A, et al. Atopic dermatitis and the role of the skin microbiome in choosing prevention, treatment, and maintenance options. J Drugs Dermatol. 2020;19(10):935-940. doi:10.36849/JDD.2020.10.36849/ JDD.2020.5393
14. Barnard E, Shi B, Kang D, et al. The balance of metagenomic elements shapes the skin microbiome in acne and health. [published correction appears in Sci Rep. 2020 Apr 2;10(1):6037]. Sci Rep. 2016;6:39491. doi:10.1038/srep39491
15. Naik S, Bouladoux N, Wilhelm C, et al. Compartmentalized control of skin immunity by resident commensals. Science. 2012;337(6098):1115-1119. doi:10.1126/science.1225152
16. Rocha MA, Bagatin E. Skin barrier and microbiome in acne. Arch Dermatol Res. 2018;310(3):181-185. doi:10.1007/s00403-017-1795-3
17. Misery L, Loser K, Ständer S. Sensitive skin. J Eur Acad Dermatol Venereol. 2016;30(Suppl 1):2-8. doi:10.1111/jdvs13532
18. Thiboutot D, Del Rosso JQ. Acne vulgaris and the epidermal barrier: is acne vulgaris associated with inherent epidermal abnormalities that cause impairment of barrier functions? Do any topical acne therapies alter the structural and/or functional integrity of the epidermal barrier? J Clin Aesthet Dermatol. 2013;6(2):18-24.
19. Tan J, Alexis A, Baldwin H, et al. The personalised acne care pathwayrecommendations to guide longitudinal management from the personalising acne: consensus of experts. JAAD Int. 2021;5:101-111. doi:10.1016/j. jdin.2021.09.006
20. Chularojanamontri L, Tuchinda P, Kulthanan K, Pongparit K. Moisturizers for acne: what are their constituents? J Clin Aesthet Dermatol. 2014;7(5):36-44.
21. Alexis AF, Woolery-Lloyd H, Williams K, et al. Racial/ethnic variations in acne: implications for treatment and skin care recommendations for acne patients with skin of color. J Drugs Dermatol. 2021;20(7):716-725. doi:10.36849/JDD.6169
22. Yamamoto A, Takenouchi K, Ito M. Impaired water barrier function in acne vulgaris. Arch Dermatol Res. 1995;287(2):214-218. doi:10.1007/BF01262335
23. Pappas A, Kendall AC, Brownbridge LC, et al. Seasonal changes in epidermal ceramides are linked to impaired barrier function in acne patients. Exp Dermatol. 2018;27(8):833-836. doi:10.1111/exd.13499
24. Meyer K, Pappas A, Dunn K, et al. Evaluation of seasonal changes in facial skin with and without acne. J Drugs Dermatol. 2015;14(6):593-601.
25. Pappas, A., Dunn, K., Cula, G.O., et al. Barrier and microbiome changes in the facial skin of children as they approach puberty. Presented at: 26th European Academy of Dermatology and Venerology(EADV) Congress: P006513-17 September 2017
26. Borodzicz S, Rudnicka L, Mirowska-Guzel D, Cudnoch-Jedrzejewska A. The role of epidermal sphingolipids in dermatologic diseases. Lipids Health Dis. 2016;15:13. doi:10.1186/s12944-016-0178-7
27. Dréno B, Pécastaings S, Corvec S, et al. Cutibacterium acnes(propionibacterium acnes) and acne vulgaris: a brief look at the latest updates. J Eur Acad Dermatol Venereol. 2018;32(Suppl 2):5-14. doi:10.1111/jdvs15043
28. Dreno B, Martin R, Moyal D, et al. Skin microbiome and acne vulgaris: staphylococcus, a new actor in acne. Exp Dermatol. 2017;26(9):798-803. doi:10.1111/exd.13296
29. Fitz-Gibbon S, Tomida S, Chiu BH, et al. Propionibacterium acnes strain populations in the human skin microbiome associated with acne. J Invest Dermatol. 2013;133(9):2152-2160. doi:10.1038/jid.2013.21
30. Gollnick H. Current concepts of the pathogenesis of acne: implications for drug treatment. Drugs. 2003;63(15):1579-1596. doi:10.2165/00003495-200363150- 00005
