Pharmacists Can Help Patients Balance the Skin Microbiome in Atopic Dermatitis With Topical Treatments
Gut bacteria and probiotic products are all the rage now, but many people aren’t as savvy about the skin microbiome and its influence in immunity and inflammation. Chances are they’re also not aware of the role it plays in skin conditions like atopic dermatitis.
Bacterial populations change in response to skin disease, offering hope for future treatments designed to support the appropriate balance. In addition to keeping up with the latest research, pharmacists can help their patients by recommending emollient creams that restore a normal microbiome.
Current Knowledge of the Skin Microbiome
Much like the gut microbiome, research into the skin microbiota is an emerging field that currently has more questions than answers, but it’s clear that microorganisms thriving on the skin are essential for a person’s health. One example is the bacterium Staphylococcus epidermidis, which secretes substances that reduce inflammation and promote wound healing. It also helps prevent colonization by S. aureus, which is also known as the superbug MRSA.
Skin microbes are known to influence immune cells in the epidermis, which in turn modulates innate and adaptive immune responses. While researchers continue to map the skin microbiome, they’ve confirmed foundational information such as:
- Predominant bacteria change depending on whether they live in dry, moist or sebaceous skin. Similar skin environments support comparable bacterial communities, although dry skin generally has a more mixed population. One study reported that corynebacteria are most predominant in moist skin, dry skin has a greater abundance of betaproteobacteria, while sebaceous skin is likely to have more propionibacteria.1
- Skin microbiome is dominated by four phyla—Actinobacteria, Firmicutes, Proteobacteria, and Bacteroidetes. The most abundant genera overall are Propionibacterium, Corynebacterium, Staphylococcus, Micrococcus, Streptococcus, and Brevibacterium.2
- Variability between individuals is high. However, the dominant types tend to remain stable between different people, while less abundant types of bacteria account for variability.
- The microbiome significantly changes during puberty. As sex characteristics develop, so does the microbiome, which may explain differences in the incidence and severity of childhood skin diseases.
- Fungal communities vary from bacterial microbiome.
Certain bacteria have been associated with specific skin disease, which means there’s hope for new treatments as the normal skin microbiome is better defined and as more information about bacterial colonies that thrive in skin disease becomes available.
Skin Microbiome in Atopic Dermatitis
The type of bacteria residing on human skin goes through substantial changes when atopic dermatitis (AD) develops. Bacterial diversity diminishes during AD flares. More specifically, actinobacteria, proteobacteria and cyanobacteria colonies decrease, while DNA profiling shows that colonization of Staphylococcus aureus increases.3 Whether the shift in favor of S. aureus causes the AD flare or is the result of AD-based damage to the skin barrier still needs to be determined.
In light of this dysbiosis, it makes sense that attention has turned to finding topical treatments that can relieve AD symptoms and prevent flares by restoring the bacterial balance. Hopefully, such future treatments will promote antimicrobial stewardship as they reduce the need for antibiotic therapies. Microbial-based treatments may also reduce reliance on topical biologics and steroids, which would be good news for many parents who prefer not to use steroids on their children. Meanwhile, evidence suggests that even a simple emollient cream makes a difference.
The Role of Emollient Treatments
Studies published so far show that emollient treatments known to improve the skin barrier in patients with AD also help restore balance to the skin’s microbiome. In November 2014, a study in the Journal of Drugs in Dermatology reported on the use of an emollient made from a lipophilic cream containing 20 percent Shea butter, 4 percent niacinamide and thermal spring water.4 Patients with AD applied the cream twice daily. They didn’t use any other topical treatments and also didn’t make any changes in hygiene practices. After 84 days, symptoms of AD improved in 72 percent of the participants. Additionally, gene sequencing showed that microbial diversity increased and Staphylococcus species decreased.
If the emollient used in the 2014 study sounds familiar, it’s because the research was funded by La Roche-Posay Pharmaceutical Laboratories (along with L’Oreal Research and Innovation) and La Roche-Posay has released an over-the-counter product with the same ingredients.5 Lipikar Baume AP+, which hit the market in March 2015, is one option to discuss with AD patients when they’re trying to choose a topical emollient.
Educate Patients About Skin Microbiome to Improve Atopic Dermatitis
Thanks to the proliferation of antibacterial skin lotions touted to stop the spread of disease, many people have come to view skin bacteria as something that’s veryy bad and undesirable. It’s a good time to start educating all your patients about the benefits of the skin microbiome, but it’s an especially vital part of counseling patients with atopic dermatitis. They don’t have to sit back and wait for future treatments that can reduce their use of steroids and antibiotics—they can begin by using existing emollient products.
Pharmaceutica North America provides emollient creams to use as bases for active ingredients, prescription drug products such as Fluocinonide cream, and high-quality bulk active pharmaceutical ingredients that help patients with atopic dermatitis. Contact us today to talk about how we can support your pharmaceutical needs.
- “Eczema, Immunity and the Skin Microbiome,” 2013, https://www.genome.gov/multimedia/slides/humanmicrobiomescience2013/21_kong.pdf ↩
- “The Human Skin Microbiome Associates with the Outcome of and Is Influenced by Bacterial Infection,” September 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4600114/ ↩
- “Restoring the Balance: Skin Microbiome in Atopic Dermatitis,” September 2016, http://dermatologytimes.modernmedicine.com/dermatology-times/news/restoring-balance-skin-microbiome-atopic-dermatitis ↩
- “Microbiome of Affected and Unaffected Skin of Patients with Atopic Dermatitis Before and After Emollient Treatment,” November 2014, http://fiererlab.org/wp-content/uploads/2014/09/Flores_dermatitis_2014.pdf ↩
- “Lipikar Baume AP+,” accessed October 2016, http://www.laroche-posay.com/products-treatments/Lipikar/Lipikar-Baume-AP-p11812.aspx ↩