Atopic dermatitis: protecting the skin from the Malassezia fungus
The microscopic fungi residing on our skin contribute to skin health. In patients suffering from severe atopic dermatitis, the Malassezia fungus has lost its dominant position, conceding – perhaps too much – territory to other species1.
About this article
Dry and itchy skin, red plaques (especially in the folds) that appear in flares: atopic dermatitis (AD) is an inflammatory skin disease that affects nearly one in five infants. Although AD tends to improve with age, it is estimated that one in ten adults suffers from the disease in developed countries.
1 in 5 Atopic dermatitis affects nearly 1 in 5 infants.
Why my child and why me? Many factors are involved, with both heredity (children of adults affected by AD are more likely to suffer from the disease) and the immune system playing important roles. Another key factor is the skin microbiota, the complex community of (sidenote: Microorganisms Living organisms that are too small to be seen with the naked eye. They include bacteria, viruses, fungi, archaea and protozoa, and are commonly referred to as “microbes”. What is microbiology? Microbiology Society. ) (bacteria, fungi, parasites, and viruses) residing on our skin.
In AD patients, some bacteria, such as Staphylococcus aureus, tend to be overrepresented, while others, such as Cutibacterium, are depleted. And what about microscopic fungi? There was no clear answer to this question until a recent study showed that the skin’s fungal flora differs in cases of severe dermatitis. Thus, while the Malassezia fungus predominates on healthy skin, it loses its prime position in AD patients. In its place, other fungi such as Candida or Debaryomyces make themselves at home. In other words, in cases of severe dermatitis, where Malassezia no longer dominates the skin fungi, there is greater fungal diversity.
Moreover, changes in the bacterial and fungal populations may be linked. For example, an increased abundance of S. aureus may favor the proliferation of Candida, as these two microorganisms have been shown to exhibit a synergistic activity.
Linked to AD severity
This skin (sidenote: Dysbiosis Generally defined as an alteration in the composition and function of the microbiota caused by a combination of environmental and individual-specific factors. Levy M, Kolodziejczyk AA, Thaiss CA, et al. Dysbiosis and the immune system. Nat Rev Immunol. 2017;17(4):219-232. ) appears to be linked to the severity of AD. With a few exceptions, the skin microbiota of patients suffering from non-severe AD is similar overall to that of individuals with healthy skin. On the other hand, the researchers found a strong divide between patients suffering from severe AD and those with healthy skin or mild-to-moderate AD. One important reason for this is lower levels of Malassezia.
The skin microbiota
1. Schmid B, Künstner A, Fähnrich A et al. Dysbiosis of skin microbiota with increased fungal diversity is associated with severity of disease in atopic dermatitis. J Eur Acad Dermatol Venereol. 2022 Jun 21.
2. Ellis SR, Nguyen M, Vaughn AR, et al. The Skin and Gut Microbiome and Its Role in Common Dermatologic Conditions. Microorganisms. 2019;7(11):550.
3. Langan SM, Irvine AD, Weidinger S. Atopic dermatitis. Lancet. 2020 Aug 1;396(10247):345-360.