Haidar Laura, Bănărescu Camelia Felicia, Uța Cristina, Zimbru Elena-Larisa, Zimbru Răzvan-Ionuț, Tîrziu Alexandru, Pătrașcu Raul, Șerb Alina-Florina, Georgescu Marius, Nistor Daciana, Panaitescu Carmen
Center of Immuno-Physiology and Biotechnologies, Department of Functional Sciences, "Victor Babeș" University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania.
Timis County Emergency Clinical Hospital "Pius Brinzeu", 156 Liviu Rebreanu Bd., 300723 Timisoara, Romania.
Biomedicines. 2025 Aug 19;13(8):2014. doi: 10.3390/biomedicines13082014.
Emerging evidence suggests a critical role of the gut microbiome in modulating systemic immune responses, with increasing relevance in dermatological diseases. Chronic spontaneous urticaria (CSU), traditionally viewed as an isolated cutaneous disorder, is now recognized as a systemic immune condition involving complex interactions between innate and adaptive immunity, mast cell dysregulation, and non-IgE-mediated pathways. This review explores the gut-skin axis as a unifying concept linking intestinal dysbiosis to inflammatory skin diseases, including atopic dermatitis, psoriasis, rosacea, and acne. Special emphasis is placed on CSU, where altered gut microbial composition, characterized by reduced diversity, depletion of short-chain fatty acid-producing bacteria, and expansion of Proteobacteria, may contribute to increased intestinal permeability, systemic immune activation via toll-like receptors, and heightened mast cell sensitivity. We discuss findings from animal models demonstrating that gut microbiota modulation can attenuate mast cell hyperreactivity and reduce urticarial symptoms. In parallel, we examine clinical evidence supporting the potential role of probiotics, prebiotics, dietary interventions, and fecal microbiota transplantation as adjunctive strategies in CSU management. Despite promising findings, challenges remain in translating microbiome research into effective therapies due to interindividual variability, the complexity of host-microbiome interactions, and a lack of standardized protocols. Future research should focus on identifying predictive microbial patterns and developing personalized microbiome-targeted interventions. Understanding the bidirectional gut-skin relationship may open new therapeutic avenues beyond symptomatic treatment, positioning the microbiome as a novel target in CSU and related inflammatory dermatoses.
新出现的证据表明，肠道微生物群在调节全身免疫反应中起关键作用，在皮肤病中的相关性日益增加。慢性自发性荨麻疹（CSU）传统上被视为一种孤立的皮肤疾病，现在被认为是一种全身免疫状况，涉及先天免疫和适应性免疫、肥大细胞失调以及非IgE介导途径之间的复杂相互作用。本综述探讨了肠-皮轴这一统一概念，它将肠道生态失调与炎症性皮肤病联系起来，包括特应性皮炎、银屑病、玫瑰痤疮和痤疮。特别强调了CSU，其肠道微生物组成改变，表现为多样性降低、产生短链脂肪酸的细菌减少以及变形菌门扩张，这可能导致肠道通透性增加、通过Toll样受体激活全身免疫以及肥大细胞敏感性增强。我们讨论了动物模型的研究结果，这些结果表明调节肠道微生物群可以减弱肥大细胞的高反应性并减轻荨麻疹症状。同时，我们研究了支持益生菌、益生元、饮食干预和粪便微生物群移植作为CSU管理辅助策略的潜在作用的临床证据。尽管有这些有前景的发现，但由于个体差异、宿主-微生物群相互作用的复杂性以及缺乏标准化方案，将微生物群研究转化为有效疗法仍面临挑战。未来的研究应专注于识别预测性微生物模式并开发针对微生物群的个性化干预措施。了解肠道与皮肤之间的双向关系可能会开辟超越对症治疗的新治疗途径，将微生物群定位为CSU和相关炎症性皮肤病的新靶点。
