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Advancements in Understanding the Skin's Microbiomes

Article

Adam Friedman, MD, FAAD, offers highlights from his session at AAD 2023 on how cutaneous dysbiosis plays a role in some common skin conditions.

At the 2023 American Academy of Dermatology (AAD) Annual Meeting in New Orleans, Louisiana, Adam Friedman, MD, FAAD, and professor and Chair of Dermatology at The George Washington University School of Medicine & Health Sciences in Washington DC, offered pearls on skin microbiomes. His session was part of a "Hot Topics" symposium, dedicated to highlighting recent trends and developments and accenting emerging and innovative therapies that are applicable to patient care.

Transcript:

Adam Friedman, MD, FAAD: I'm Dr. Adam Friedman Professor and Chair of dermatology at GW School of Medicine and Health Sciences. Every person has a unique bacterial fingerprint; no 2 walking petri dishes are the same, so to speak, but even throughout our body, you know, think of as like a planet to these microorganisms, different locations in the body have a different bacterial signature in terms of the populations living there, just like different ecosystems on the planet Earth. And so when thinking about these different populations, the most important thing to remember is diversity matters. This is true across all walks of life at the macro level, but especially at the micro level, you want them to play nicely in the sandbox. And when we think of the term dysbiosis, when it comes to cutaneous dysbiosis and related diseases, it has to do with decreased diversity. Certain microorganisms are going outside their lane so to speak, overgrowing and taking over and others are dwindling or disappearing. Now, when we try to think about how that relates to what we do on a daily basis, our daily recommendations to patients influence the microbiota; the microorganisms that live on the skin. Moisturizer use and topical therapy use (both good and bad so to speak in terms of different therapies ) influence the petri dish, and even procedures we do can influence the petri dish and by default, influence who can survive where. When we start to think about what diseases have dysbiosis as a centerpiece of their pathophysiology, atopic dermatitis comes to the very top of that list, and a lot of great work from colleagues at NIH like Heidi Kang, Ian Myles, Rich Gallo at UCSD, have really moved the needle on an understanding of how important that diversity is. With atopic dermatitis, we now know that decreasing diversity; that alteration in the players on the skin, often happens before you even see clinical disease. So that decrease in diversity will precede clinical flares. And that really highlights the importance of maintaining a healthy living skin barrier. On the flip side, we know that treatments will influence this cutaneous microbiota, those living organisms, discern microbiota or the living organisms, the microbiome is the genetic makeup just to kind of help understand some of those definitions. So topical steroid use has been shown to bring someone back to their baseline in terms of diversity, certainly, in some atopic dermatitis, their microbiota is not going to be that diverse or, or that kind of complete, like you would see with someone who doesn't have atopic dermatitis, we have emerging evidence that our new systemic therapies can do the same thing. Now forgetting those advanced and really cool therapies that we get to play with nowadays, simple measures can be very important. Incorporating a barrier protecting a moisturizer that has prebiotics, things that are needed for the organism to live in the skin to survive and thrive, potentially even probiotics actually living organisms, or post biotics or metabolomics; there are a couple of different terms for this. But pretty much in essence, what all these entail are either dead bacterial parts or something that bacteria make that can influence the skin barrier or the local immune system. And what I typically say is, it's not about one or the other, it's that an ideal product will contain them all. Because if you just throw living organisms in a hostile environment, they're not going to survive. However, if you give them support prebiotics, and you enable them to produce the things that are needed for the environment to settle and really be an ideal environment for survival, then the right players emerge and grow and flourish. So it's important for us to be mindful of that. Regardless of what someone is on. we're focusing on maintaining a healthy physical barrier, so the living barrier can certainly do its thing.

This transcript has been edited for clarity and length.

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