Innovative Microbial Strategies in Atopic Dermatitis

Jingtai Ma^1,2Yiting Fang^1,2JINXING HU²Shiqi Li¹Lilian Zeng¹Siyi Chen¹Zhifeng Li¹Ruilin Meng³Xing-Fen Yang⁴Fenglin Zhang⁵Guiyuan Ji¹Liang Chen^2*Wei Wu^1,6*

• ¹Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
• ²Guangzhou Chest Hospital, Guangzhou, Guangdong Province, China
• ³Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
• ⁴Guangdong Provincial Key Laboratory of Tropical Diseases, Southern Medical University, Guangzhou, Guangdong Province, China
• ⁵Guangzhou Institute of Microbiology, Guangzhou, China
• ⁶Zhuhai Center for Disease Control and Prevention, Zhuhai, Guangdong Province, China

Atopic dermatitis (AD) is characterized by chronic and recurrent itching with a high burden of disability-adjusted life years (DALYs, a measure of overall disease burden). Traditional treatments mainly include corticosteroids, which have a good effect on controlling inflammation but adverse side effects. Recently, advancements in understanding the pathogenesis of AD have led to the emergence of a variety of novel therapeutic approaches, such as microbiome manipulation, offering renewed hope for more effective management of this condition. These strategies are particularly promising for mildto-moderate AD, where dysbiosis and immune imbalance (e.g., Th2 skewing) are key drivers, though some approaches (e.g., fecal microbiota transplantation) are being explored for refractory cases. It has been shown that microbiome manipulation has the potential to improve disease states and regulates the balance of the inflammatory system in a variety of ways. Various approaches have been preclinically and clinically tested, including probiotics (and multiple co-applications), prebiotics, postbiotics, unmethylated CpG motifs, fecal microbiota transplantation, herbal fermentation technology with microorganisms and phage. In this review, we discuss these microbiome manipulation methods and emphasizes the potential of microbiome-based interventions to modulate Th1/Th2 balance with fewer side effects, ultimately leading to control of inflammation in AD. Further translational research in this field is needed to integrate when we apply this therapy and the capability for disease treatment and prevention.