SKIN is the largest organ of the body.

It is as a massive fortified barrier to protect our body regulating temperature and keeping out foreign pathogen microorganisms, such as bacteria and viruses.

State of Art

This last aim is achieved also by the alliance between the immune system and a wide and complex population of microorganisms residing on the skin, the so-called “Skin Microbiota”. (1) (2)

Multiple environmental and genetic factors can disturb this delicate balance, altering the skin barrier. This dysregulation predisposes our body to a number of cutaneous infectious and inflammatory conditions contributing to the dramatic and rapid increase in chronic inflammatory cutaneous diseases. (3) (4)

Most common chronic inflammatory skin disorders, such as atopic and seborrheic dermatitis; psoriasis and acne can differ significantly in symptoms, manifestations, severity and duration. They have all been associated with the microbial imbalance of skin microbiota (5). Advances in microbiology and immunology are revising our understanding of the molecular mechanisms of microbial virulence and the specific events involved in the host-microbe interaction.

“Microbes found on the skin are usually regarded as pathogens, potential pathogens or innocuous symbiotic organisms. Current data contradict some historical classifications of cutaneous microbiota and suggest that these organisms may protect the host, defining them not as simple symbiotic microbes but rather as mutualistic.”

State of Art

This last aim is achieved also by the alliance between the immune system and a wide and complex population of microorganisms residing on the skin, the so-called “Skin Microbiota”. (1) (2)

Multiple environmental and genetic factors can disturb this delicate balance, altering the skin barrier. This dysregulation predisposes our body to a number of cutaneous infectious and inflammatory conditions contributing to the dramatic and rapid increase in chronic inflammatory cutaneous diseases. (3) (4)

Most common chronic inflammatory skin disorders, such as atopic and seborrheic dermatitis; psoriasis and acne can differ significantly in symptoms, manifestations, severity and duration. They have all been associated with the microbial imbalance of skin microbiota (5). Advances in microbiology and immunology are revising our understanding of the molecular mechanisms of microbial virulence and the specific events involved in the host-microbe interaction.

“Microbes found on the skin are usually regarded as pathogens, potential pathogens or innocuous symbiotic organisms. Current data contradict some historical classifications of cutaneous microbiota and suggest that these organisms may protect the host, defining them not as simple symbiotic microbes but rather as mutualistic.”

Disease and Market

Atopic Dermatitis (eczema), caused by a dysregulation of the adaptive and innate immune response (6), it has long been associated with S. Aureus skin infection (7). Typically, the onset occurs in 15-20% of children below 10 years and 1-3% of adults worldwide affecting more than 330 million patients (8).

Symptoms include itchy, redness, swollen, cracked skin and sensitization to allergens with a dramatic impact on patient’s quality life (9).

Current Therapies

Therapies available for Atopic Dermatitis are based mostly on steroid drugs, immunomodulating drugs, calcineurin inhibitors and moisturizing creams (10). Regarding the Mild to moderate grade, around 80% of the total patients, representing many of them are affected by “The Corticosteroid phobia” and upset about the side effects of unspecific immunosuppressant drugs (11) (12). In recent years many Companies heve tried to develop products, especially with immunosuppressive activity, with poor results. Develop alternative, effective and less invasive treatment is quite important to enhance patient’s satisfaction, reminding that almost all users are in pediatric age.

Disease and Market

Atopic Dermatitis (eczema), caused by a dysregulation of the adaptive and innate immune response (6), it has long been associated with S. Aureus skin infection (7). Typically, the onset occurs in 15-20% of children below 10 years and 1-3% of adults worldwide affecting more than 330 million patients (8).

Symptoms include itchy, redness, swollen, cracked skin and sensitization to allergens with a dramatic impact on patient’s quality life (9).

Current Therapies

Therapies available for Atopic Dermatitis are based mostly on steroid drugs, immunomodulating drugs, calcineurin inhibitors and moisturizing creams (10). Regarding the Mild to moderate grade, around 80% of the total patients, representing many of them are affected by “The Corticosteroid phobia” and upset about the side effects of unspecific immunosuppressant drugs (11) (12). In recent years many Companies heve tried to develop products, especially with immunosuppressive activity, with poor results. Develop alternative, effective and less invasive treatment is quite important to enhance patient’s satisfaction, reminding that almost all users are in pediatric age.

References

1. Belkaid Y, Hand TW. Role of the microbiota in immunity and inflammation. Cell. 2014;157(1):121-41.
2. Grice EA, Kong HH, Conlan S, Deming CB, Davis J, Young AC, et al. Topographical and temporal diversity of the human skin microbiome. Science. 2009;324(5931):1190-2.
3. Lee N, Kim WU. Microbiota in T-cell homeostasis and inflammatory diseases. Exp Mol Med. 2017;49(5):e340.
4. Gallo RL. Human skin is the largest epithelial surface for interaction with microbes. J Invest Dermatol. 2017;137:1213-1214.
5. Cogen AL, Nizet V, Gallo RL. Skin microbiota: a source of disease or defence?.Br J Dermatol. 2008; 158(3):442-55.
6. Teruaki Nakatsuji, Richard L. Gallo. The role of the skin microbiome in atopic dermatitis. Annals of Allergy, Asthma & Immunology 2018. https://doi.org/10.1016/j.anai.2018.12.003
7. Geoghegan JA, Irvine AD, Foster TJ. Staphylococcus aureus and Atopic Dermatitis: A Complex and Evolving Relationship. Trends Microbiol.2018;26(6):484-97.
8. Nutten S. Atopic dermatitis: global epidemiology and risk factors. Ann Nutr Metab.2015;66 Suppl 1:8-16.

9. Lifschitz C. The impact of atopic dermatitis on quality of life. Ann Nutr Metab.2015;66 Suppl 1:34-40.
10. Fernandez JM, Fernandez AP, Lang DM. Biologic Therapy in the Treatment of Chronic Skin Disorders. Immunol Allergy Clin North Am. 2017;37(2):315-27
11. Coondoo A, Phiske M, Verma S, Lahiri K. Side-effects of topical steroids: A long overdue revisit. Indian Dermatol Online J. 2014;5(4):416-25.
12. Li AW, Yin ES, Antaya RJ. Topical Corticosteroid Phobia in Atopic Dermatitis: A Systematic Review. JAMA Dermatol. 2017;153(10):1036-42.
13. Mangano K, Vergalito F, Mammana S, Mariano A, De Pasquale R, Meloscia A, et al.Evaluation of hyaluronic acid-P40 conjugated cream in a mouse model of dermatitis induced by oxazolone. Exp Ther Med. 2017;14(3):2439-44.
14. Journal of Clinical & Experimental Dermatology Research Milani et al., J Clin Exp Dermatol Res 2017, 8:6

DOI: 10.4172/2155-9554.1000426

1. Belkaid Y, Hand TW. Role of the microbiota in immunity and inflammation. Cell. 2014;157(1):121-41.
2. Grice EA, Kong HH, Conlan S, Deming CB, Davis J, Young AC, et al. Topographical and temporal diversity of the human skin microbiome. Science. 2009;324(5931):1190-2.
3. Lee N, Kim WU. Microbiota in T-cell homeostasis and inflammatory diseases. Exp Mol Med. 2017;49(5):e340.
4. Gallo RL. Human skin is the largest epithelial surface for interaction with microbes. J Invest Dermatol. 2017;137:1213-1214.
5. Cogen AL, Nizet V, Gallo RL. Skin microbiota: a source of disease or defence?.Br J Dermatol. 2008; 158(3):442-55.
6. Teruaki Nakatsuji, Richard L. Gallo. The role of the skin microbiome in atopic dermatitis. Annals of Allergy, Asthma & Immunology 2018. https://doi.org/10.1016/j.anai.2018.12.003
7. Geoghegan JA, Irvine AD, Foster TJ. Staphylococcus aureus and Atopic Dermatitis: A Complex and Evolving Relationship. Trends Microbiol.2018;26(6):484-97.
8. Nutten S. Atopic dermatitis: global epidemiology and risk factors. Ann Nutr Metab.2015;66 Suppl 1:8-16.
9. Lifschitz C. The impact of atopic dermatitis on quality of life. Ann Nutr Metab.2015;66 Suppl 1:34-40.
10. Fernandez JM, Fernandez AP, Lang DM. Biologic Therapy in the Treatment of Chronic Skin Disorders. Immunol Allergy Clin North Am. 2017;37(2):315-27
11. Coondoo A, Phiske M, Verma S, Lahiri K. Side-effects of topical steroids: A long overdue revisit. Indian Dermatol Online J. 2014;5(4):416-25.
12. Li AW, Yin ES, Antaya RJ. Topical Corticosteroid Phobia in Atopic Dermatitis: A Systematic Review. JAMA Dermatol. 2017;153(10):1036-42.
13. Mangano K, Vergalito F, Mammana S, Mariano A, De Pasquale R, Meloscia A, et al.Evaluation of hyaluronic acid-P40 conjugated cream in a mouse model of dermatitis induced by oxazolone. Exp Ther Med. 2017;14(3):2439-44.
14. Journal of Clinical & Experimental Dermatology Research Milani et al., J Clin Exp Dermatol Res 2017, 8:6

DOI: 10.4172/2155-9554.1000426