Improving understanding of the skin microbiome to advance the treatment of AD



Multiple factors such as physiology, environment, immune system, genotype, lifestyle, and pathobiology contribute to a person’s skin microbiota. Lawrence J. Green, MD, FAAD, Clinical Professor of Dermatology at the George Washington University School of Medicine in Washington DC offered an in-depth exploration of the relationship between skin microbiome and barrier function at the Fall Clinical Dermatology Conference 2021 to be held in October. From 21 to 24 2021 in Las Vegas, Nevada, and virtually.1

The interaction between the cutaneous commensals and the barrier function of the skin can lead to inflammation. This gives added importance to the role of the skin barrier as it prevents harmful substances from entering the stratum corneum, Green explained.

He highlighted the results of the study2 which showed that the higher proportion of staphylococci (with the largest of S. Aureus) correlated with more severe flare-ups of atopic dermatitis (AD). DA flare-ups have also been shown to be associated with decreased bacterial diversity in the skin.

Skin affected by AD and unaffected by AD has different microbiomes, Green said. There are more staphylococci on the skin of patients with AD. However, both have an abundance of firmicutes3.

Green has identified 4 agents that could help rebalance the microbiome4.5:

  • The water
  • Carbon sources
  • Nitrogen sources
  • Trace elements

Prebiotics and postbiotics are non-living agents that stimulate the growth of native bacteria, which can help with flare-ups, according to Green. He noted that roseomonas mucosa has been identified as the most common Gram-negative skin organism in people without AD, but mostly absent in patients with AD.5.6

He pointed out that strains of roseomonas mucosa can induce markers of the vitamin D pathway and can help suppress staphylococci (including MRSA). According to Green, this means colonization of the roseomonas lining on the skin may help as a probiotic for AD.

He noted that La Roche-Posay Thermal Spring Water [LRP-TSW] can greatly reduce the severity of AD and staph genus disease while increasing the level of the genus Xanthomonas7. The study found that an emollient in this product prepared with a high concentration of LRP-TSW demonstrated a positive impact on the microbiome of patients with AD associated with a longer time between AD flares compared to an emollient. -competitive prebiotic, according to Green7.

Understanding the skin microbiome can help doctors treat patients with AD better, Green concluded.


Lawrence J. Green, MD, FAAD, is a researcher and advisor for Arcutis Biotherapeutics, Dermavant Sciences, Forte and LaRoche-Posay.


  1. Green L. Considering the skin microbiome in the management of barrier repair and atopic dermatitis. Presented at: 2021 Fall Clinical Dermatology Conference, October 21-24, 2021 in Las Vegas, Nevada and Virtual.
  2. Kong HH, Oh J, Deming C, et al. Temporal changes in the skin microbiome associated with disease flare-ups and treatment in children with atopic dermatitis. Genome Res. 2012; 22 (5): 850-859. doi: 10.1101 / gr.131029.111
  3. Conners SB, Mongodin EF, Johnson MR, Montero CI, Nelson KE, Kelly RM. Microbial biochemistry, physiology and biotechnology of hyperthermophilic Thermotoga species. FEMS microbiology reviews. 2006; 30 (6): 872-905. doi: 10.1111 / j.1574-6976.2006.00039.x
  4. Wackett LP, Dodge AG, Ellis LBM. Microbial genomics and periodic table. Appl Environ Microbiol. 2004; 70 (2): 647-655. doi: 10.1128 / AEM.70.2.647-655.2004
  5. Myles IA, Williams KW, Reckhow JD, et al. Transplantation of human skin microbiota in models of atopic dermatitis. JCI Overview. 2016; 1 (10). doi: 10.1172 / jci.insight.86955
  6. Li M, Hener P, Zhang Z, Kato S, Metzger D, Chambon P. Topical vitamin D3 and low calcium analogues induce thymic stromal lymphopoietin in mouse keratinocytes and trigger atopic dermatitis. Proc Natl Acad Sci USA. 2006; 103 (31): 11736-11741. doi: 10.1073 / pnas.0604575103
  7. 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.


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