Emerging microbiome-based therapies for atopic dermatitis: clinical insights and future development

Despite growing evidence that environmental factors and microbiome dysbiosis constitute the majority of disease pathogenesis, most current therapies target inflammation, barrier dysfunction, and/or S. aureus overgrowth. However, given the emerging understanding of microbiome-mediated and environmentally driven disease mechanisms, expanding therapeutic strategies to include dysbiosis and upstream environmental contributors represents a promising direction for future research.

This manuscript will review the strengths and limitations of the standard treatments for AD, including emollients, topical corticosteroids, calcineurin inhibitors, and systemic immunomodulators. The focus, however, will be on the emerging microbiome-based therapies, specifically products containing live microorganisms (biotherapeutics). The potential for, and challenges against, biotherapeutics to grow within the market of AD treatment will be discussed.

Immune suppressive approaches will remain limited to symptomatic control. These treatments will also be limited by tradeoffs inherent to the balance between symptom control and side effects of immune suppression. To successfully aide patients, topical biotherapeutics will need to overcome pharmaceutical-centric paradigms, academic dogma, and regulatory inertia. Limitations in current therapies and patient needs, along with the potential to offer prevention against AD development, will likely propel biotherapeutics forward.