Title : The skin microbiome in pediatric atopic dermatitis: Emerging biomarkers and prospects for personalized treatment
Abstract:
Atopic dermatitis (AD) is children's most common chronic inflammatory skin disease. Recent studies implicate the skin microbiome—particularly Staphylococcus aureus overgrowth and reduced microbial diversity—as a key driver of disease severity and flares. This narrative review evaluates current evidence on how the skin microbiome contributes to pediatric AD and highlights its emerging role as a source of clinical biomarkers.
Objective: To synthesize recent (2020–2025) PubMed-indexed human studies that examine the microbial composition, pathophysiologic mechanisms, and potential diagnostic or predictive roles of the skin microbiome in pediatric AD. Gaps in knowledge and future research directions are also explored.
Methods: A narrative review of English-language, peer-reviewed human studies published from 2020 onward was conducted. Search terms included “atopic dermatitis,” “pediatric,” “skin microbiome,” “dysbiosis,” and “biomarker.” Selected studies were synthesized based on microbial trends, mechanistic relevance, and translational potential.
Results: Children with AD consistently exhibit dysbiosis, notably S. aureus predominance and reduced commensal diversity. S. aureus abundance correlates with disease severity, while commensals like Staphylococcus epidermidis and Roseomonas mucosa have protective roles. Treatment with biologics (e.g., dupilumab) or topical anti-inflammatories reduces S. aureus colonization and restores microbial diversity, suggesting a feedback loop between inflammation and dysbiosis. Microbiome-based indices and S. aureus quantification show promise as biomarkers for monitoring severity and predicting treatment response. However, significant gaps remain: lack of longitudinal pediatric studies, limited data on the skin of color, and absence of standardized, clinically applicable microbiome assays.
Conclusion: The skin microbiome is a critical, modifiable factor in pediatric AD and may soon complement traditional tools in diagnosis and treatment. Future research must prioritize diverse, longitudinal cohorts and translational applications to unlock the full potential of microbiome-informed, personalized dermatology.
