SKIN is the body’s largest organ.

Skin is a protective barrier that regulates body temperature and is our first line of defense against foreign pathogens, including bacteria and viruses.

Microbiota

Skin function is a balance between the immune system and a large and complex population of microorganisms residing on our skin, called skin microbiota (1) (2).

Numerous environmental and genetic factors can affect this delicate balance, altering the skin’s barrier. This leaves the body vulnerable to a number of cutaneous infectious and inflammatory conditions that can contribute 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 terms of symptoms, severity and duration. They have all been associated with a microbial imbalance of the skin microbiota (5). Advances in microbiology and immunology are improving our understanding of the molecular mechanisms of microbial virulence and of what is involved in 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.” (5)

Microbiota

Skin function is a balance between the immune system and a large and complex population of microorganisms residing on our skin, called skin microbiota (1) (2).

Numerous environmental and genetic factors can affect this delicate balance, altering the skin’s barrier. This leaves the body vulnerable to a number of cutaneous infectious and inflammatory conditions that can contribute 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 terms of symptoms, severity and duration. They have all been associated with a microbial imbalance of the skin microbiota (5). Advances in microbiology and immunology are improving our understanding of the molecular mechanisms of microbial virulence and of what is involved in 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.” (5)

Disease and the market

Atopic dermatitis (eczema), caused by an imbalance of the adaptive and innate immune response (6), has long been associated with Staphylococcus aureus skin infections (7). Typically, onset occurs in 15–20% of children under 10 years and 1–3% of adults worldwide, affecting over 330 million individuals (8). Symptoms include itchy, red, swollen and cracked skin as well as sensitivity to allergens, resulting in a dramatic impact on quality of life (9).

Current treatment

Treatment option for atopic dermatitis are primarily based on steroid drugs, immunomodulating drugs, calcineurin inhibitors and moisturizing creams (10). Approximately 80% of total patients with mild to moderate forms of atopic dermatitis have a “corticosteroid phobia” and are troubled by the side effects of immunosuppressant drugs (11) (12). In recent years, many companies have developed products, especially based on immunosuppressants, yet with poor results. Developing an alternative, effective and less invasive treatment for atopic dermatitis is important to enhancing patients’ quality of life, especially considering that a majority of those affected are children.

Disease and the market

Atopic dermatitis (eczema), caused by an imbalance of the adaptive and innate immune response (6), has long been associated with Staphylococcus aureus skin infections (7). Typically, onset occurs in 15–20% of children under 10 years and 1–3% of adults worldwide, affecting over 330 million individuals (8). Symptoms include itchy, red, swollen and cracked skin as well as sensitivity to allergens, resulting in a dramatic impact on quality of life (9).

Current treatment

Treatment option for atopic dermatitis are primarily based on steroid drugs, immunomodulating drugs, calcineurin inhibitors and moisturizing creams (10). Approximately 80% of total patients with mild to moderate forms of atopic dermatitis have a “corticosteroid phobia” and are troubled by the side effects of immunosuppressant drugs (11) (12). In recent years, many companies have developed products, especially based on immunosuppressants, yet with poor results. Developing an alternative, effective and less invasive treatment for atopic dermatitis is important to enhancing patients’ quality of life, especially considering that a majority of those affected are children.

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