La Roche-Posay Laboratoire Dermatologique, Levallois Perret, France.
L'Oréal Research and Innovation, Aulnay-sous-Bois, France.
J Eur Acad Dermatol Venereol. 2023 Jun;37 Suppl 5:3-17. doi: 10.1111/jdv.19125.
A dysfunctional epidermal barrier, which may be associated with mutations in the filaggrin gene in genetically predisposed individuals or harmful effects of environmental agents and allergens, contributes to the development of atopic dermatitis (AD) due to an interplay between the epithelial barrier, immune defence and the cutaneous microbiome. The skin of patients with AD is frequently over-colonized by biofilm-growing Staphylococcus aureus, especially during flares, causing dysbiosis of the cutaneous microbiota and a decrease in bacterial diversity that inversely correlates with AD severity. Specific changes in the skin microbiome can be present before clinical AD onset in infancy. Additionally, local skin anatomy, lipid content, pH, water activity and sebum secretion differ between children and adults and generally correlate with the predominant microbiota. Considering the importance of S. aureus in AD, treatments aimed at reducing over-colonization to rebalance microbial diversity may help manage AD and reduce flares. Anti-staphylococcal interventions in AD will contribute to a decrease in S. aureus superantigens and proteases that cause damage and inflammation of the skin barrier while concomitantly increasing the proportion of commensal bacteria that secrete antimicrobial molecules that protect healthy skin from invading pathogens. This review summarizes the latest data on targeting skin microbiome dysbiosis and S. aureus over-colonization to treat AD in adults and children. Indirect AD therapies, including emollients 'plus', anti-inflammatory topicals and monoclonal antibodies, may have an impact on S. aureus and help control bacterial diversity. Direct therapies, including antibacterial treatments (antiseptics/topical or systemic antibiotics), and innovative treatments specifically targeting S. aureus (e.g. anti-S. aureus endolysin, and autologous bacteriotherapy), may be effective alternatives to mitigate against an increase in microbial resistance and allow a proportionate increase in the commensal microbiota.
功能失调的表皮屏障,可能与遗传易感个体中丝聚合蛋白基因的突变或环境因素和过敏原的有害影响有关,通过上皮屏障、免疫防御和皮肤微生物组的相互作用,导致特应性皮炎(AD)的发展。AD 患者的皮肤经常被生物膜生长的金黄色葡萄球菌过度定植,特别是在发作期间,导致皮肤微生物组的失调和细菌多样性减少,这与 AD 的严重程度呈反比。在婴儿期 AD 发病前,皮肤微生物组可能会出现特定的变化。此外,儿童和成人的局部皮肤解剖结构、脂质含量、pH 值、水活度和皮脂分泌不同,通常与主要微生物群相关。考虑到金黄色葡萄球菌在 AD 中的重要性,旨在减少过度定植以恢复微生物多样性的治疗方法可能有助于控制 AD 和减少发作。AD 中的抗葡萄球菌干预措施将有助于减少金黄色葡萄球菌超抗原和蛋白酶,这些物质会破坏和炎症皮肤屏障,同时增加分泌抗菌分子的共生菌的比例,这些分子可保护健康的皮肤免受入侵病原体的侵害。这篇综述总结了针对皮肤微生物组失调和金黄色葡萄球菌过度定植以治疗成人和儿童 AD 的最新数据。间接 AD 疗法,包括保湿剂“加用”、抗炎局部治疗和单克隆抗体,可能对金黄色葡萄球菌有影响,并有助于控制细菌多样性。直接疗法,包括抗菌治疗(防腐剂/局部或全身抗生素)和专门针对金黄色葡萄球菌的创新治疗(例如抗金黄色葡萄球菌内溶素和自体细菌疗法),可能是减轻微生物耐药性增加的有效替代方法,并允许共生微生物群适度增加。
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