The skin microbiome in dermatologic disease

Abstract

In Part I of our CME, we reviewed the skin microbiome in healthy individuals. Part II reviews the evolving understanding of alterations in the skin microbiome in specific human diseases. We also discuss how the skin microbiome can change with environmental exposures and medications such as antibiotics, as well as ongoing research on microbiome-based interventions.

Keywords: antibiotics; antimicrobial resistance; fecal microbiota transplantation; inflammatory skin diseases; microbiome-based therapeutics; prebiotics; probiotics.

Fig 1.

Relative abundance of bacteria on the skin of healthy control children and children with atopic dermatitis flares at the level of phylum/genus (upper row) and Staphylococcal species (lower row). Each bar in the bar charts represents a single individual. Samples were collected from the antecubital and popliteal fossa and averaged together for each subject. Adapted from Byrd et al.

Fig 2.

Bacterial culture results showing emergence of doxycycline-resistant skin bacteria in healthy volunteers following 56 days of doxycycline treatment. Skin swabs were collected at Day 0 and Day 56 after doxycycline and were plated on growth media with or without doxycycline and in either aerobic or anaerobic conditions. Representative images of culture plates are shown with bacterial colonies growing in each condition along with the corresponding quantification (number of colonies per plate). A and B represent two different study subjects. Adapted from Jo et al.

Fig 3.

Flow diagram showing factors affecting the clinical translation of microbiome-based therapeutics. Purple bubbles include current gaps limiting translation, and yellow bubbles include recommendations for future studies that may improve the clinical applicability of microbiome-based therapies.