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Pediatrics

Expert interview: Pr. Brigitte Dréno

Immunity

Atopic dermatitis (AD) is a chronic inflammatory skin disease that appears in periodic flareups. Like asthma, hay fever or allergic conjunctivitis, it is classified as an allergic disease. The disease causes very poorly defined oozing red lesions to appear in specific locations on the skin, such as in the folds of the elbow or behind the knees, but at times also on the face or the rest of the body. AD usually appears in early childhood, and may persist into adulthood. The causes are multifactorial and complex and include a genetic predisposition (mutation of the skin protein, filaggrin), an alteration of the skin barrier, a dysbiosis of the skin and gut microbiota, and immune dysregulation.

AD affects 15%-20% of children and 10% of adults in “developed” countries. The number of cases has increased significantly in recent decades due to pollution and contact with allergens.1

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Author

Pr. Brigitte Dréno
Created 24 November 2021
Updated 22 July 2024

What factors cause flare-ups ? 


Inflammatory outbreaks can be triggered by multiple factors, including stress, pollution, cold, humidity, certain allergens (pollen), certain medications, woolen clothing, and certain cosmetics containing plants or essential oils.

The causes of atopic dermatitis are multifactorial and complex and include a genetic predisposition, an alteration of the skin barrier, a dysbiosis of the skin and gut microbiota, and immune dysregulation.

Pr. Brigitte Dréno

What do we know about the links between atopic dermatitis, the microbiota and immunity?

On a pathophysiological level, AD is characterized by an alteration of the skin barrier, a skin and gut dysbiosis, and immune dysregulation with the activation of Th2 lymphocytes. This immune dysregulation leads to a major cytokine surge, which in turn causes the inflammatory reactions.2

An alteration of the skin barrier is the starting point for a dysbiosis of the skin microbiota characterized by a reduction in bacterial diversity and the proliferation of Staphylococcus aureus. Allergen penetration leads to the activation of keratinocytes and the production of interleukin (IL-33, IL-25, TSLP), resulting in the differentiation of Th2 lymphocytes. These in turn secrete pro-inflammatory cytokines (IL-4, IL-5 and IL-13) characteristic of Type 2 inflammation (Fig 9). These cytokines directly activate the sensory nerves, provoking pruritus.

With chronic lesions, the skin barrier repairs itself poorly and becomes thicker, since it is subject to chronic inflammation. There is also a progressive increase in cytokines and Th cells (Th1, Th2, Th22) which secrete cytokines that contribute to the destruction of keratinocytes. Lastly, a gut dysbiosis may play a role in the disease’s pathophysiological mechanism.3

FIGURE 9: Pathogenesis, main mechanisms and pathophysiology of atopic dermatitis.


Adapted from Sugita K et al, 20204

What have recent discoveries about the microbiota taught you? Has your practice changed?

Recent discoveries about the microbiota have led me to better understand the importance of maintaining and repairing the skin barrier to control inflammation. As a systemic treatment, I advise my patients to use a cleansing gel that preserves the skin’s pH (pH ~5, avoid products with a basic pH), as well as a moisturizer and tailored cosmetic products. The findings also help us to better understand the skin’s immunological system and how to respect the skin’s microbiota.

The immune dysregulation in atopic dermatits leads to a major cytokine surge, which in turn causes the inflammatory reactions.2

Pr. Brigitte Dréno

What are your thoughts on the use of probiotics to treat AD or prevent relapse?

There are many ways to rebalance the skin microbiota in case of AD (probiotics, prebiotics, symbiotics, etc.)5 but the postbiotic approach seems to me the most interesting. Postbiotics are preparations of inanimate microorganisms and/or their components that confers a health benefit on the host.6 They can restore the skin barrier via an anti-inflammatory action that allows bacteria to recolonize, therefore having a long-term impact on the microbiota. Oral probiotics or prebiotics are another interesting approach to regulating the intestinal system, which itself plays a general immunomodulatory role in the immune system.7

Sources

1 Ständer S. Atopic Dermatitis. N Engl J Med. 2021 Mar 25;384(12):1136-1143.

2 Langan SM, Irvine AD, Weidinger S. Atopic dermatitis. Lancet. 2020 Aug 1;396(10247):345-360.

3 Kim JE, Kim HS. Microbiome of the Skin and Gut in Atopic Dermatitis (AD): Understanding the Pathophysiology and Finding Novel Management Strategies. J Clin Med. 2019 Apr 2;8(4):444. 

4 Sugita K, Akdis CA. Recent developments and advances in atopic dermatitis and food allergy. Allergol Int. 2020 Apr;69(2):204-214. 

5 Li W, Yosipovitch G. The Role of the Microbiome and Microbiome-Derived Metabolites in Atopic Dermatitis and Non-Histaminergic Itch. Am J Clin Dermatol. 2020 Sep;21(Suppl 1):44-50. 

6 Salminen S, Collado MC, Endo A, et al. The International Scientific Association of Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of postbiotics. Nat Rev Gastroenterol Hepatol. 2021 May 4. 

Tags
Immunity Skin microbiota Gut microbiota Atopic Dermatitis Eczema Dysbiosis Staphylococcus aureus Gut-skin axis Flare-up Dermatology Microbiome Flora
    Focus
    Microbiota, a diplomatic immunity?
    • Introduction
      • Understanding the complex interplay between the microbiota and immunity is only just beginning
    • Intestinal Immunity
      • The infant's gut at the heart of immunity
      • Factors influencing microbiota development and maturation of the immune system early in life
      • The impact of western diet on the mucus layer
      • Dampening gastrointestinal inflammation through nutrition
    • Gut microbiota influences respiratory immunity
      • The gut microbiota is involved in the lung’s defense against viral respiratory infections
      • Gut-lung axis in viral respiratory infections
      • The hygiene hypothesis and the COVID-19 pandemic
      • Targeting the gut microbiota to optimize vaccine efficacy?
    • Role of the microbiota in skin immunity and atopic dermatitis
      • Expert interview: Pr. Brigitte Dréno
    • Conclusion
      • What to take away? Intestinal Immunity
      • What to take away? Respiratory immunity
      • What to take away? Skin immunity
    Created 24 November 2021
    Updated 22 July 2024

    About this article

    To know more about this topic.

    Main topic

    Immunity

    Content type

    Dossier detail

    Author

    Pr. Brigitte Dréno
    Targeting the gut microbiota to optimize vaccine efficacy?
    What to take away? Intestinal Immunity
    Focus

    Microbiota, a diplomatic immunity?

    Introduction

    Understanding the complex interplay between the microbiota and immunity is only just beginning

    Intestinal Immunity

    The infant's gut at the heart of immunity Factors influencing microbiota development and maturation of the immune system early in life The impact of western diet on the mucus layer Dampening gastrointestinal inflammation through nutrition

    Gut microbiota influences respiratory immunity

    The gut microbiota is involved in the lung’s defense against viral respiratory infections Gut-lung axis in viral respiratory infections The hygiene hypothesis and the COVID-19 pandemic Targeting the gut microbiota to optimize vaccine efficacy?

    Role of the microbiota in skin immunity and atopic dermatitis

    Expert interview: Pr. Brigitte Dréno

    Conclusion

    What to take away? Intestinal Immunity What to take away? Respiratory immunity What to take away? Skin immunity

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