7.2 Skin barrier as a potential target for treatment – new developments
The disturbed skin barrier offers a variety of novel leverage points for future AE treatment. One option would be to tackle the dysbalanced skin microbiome with pre- and probiotics. A study achieved positive results by applying heat-treated Lactobacillus johnsonii NCC 533 on AE skin [118]. The topical microbiome transplant of Roseomonas mucosa from healthy participants to AE patients improved AE severity in a clinical I/II safety and activity trial [119]. As S. aureusis one of the driving factors in AE, multiple strategies to controlS. aureus growth emerged. An active reduction of S. aureuscould be achieved with competing coagulase negative staphylococci (CoNS) which produce antimicrobial peptides against S. aureus [120]. Furthermore, it could be shown that CoNS could inhibit quorum sensing and thereby virulence of S. aureus [121, 122]. Another strategy is to shift the microenvironment towards unfavorable conditions for S. aureus . As acidic and alkaline pH seems to limit the growth of S. aureus in vitro and in vivo, acidification of the skin could be one strategy. However, sustained acidification of the skin was not yet successful [64, 123]. Therefore, more acidic products, well-buffered products or a more continuous application of the emollient could be beneficial. Dilute bleach baths also do not reduce S. aureus load and AE severity in vivo or in vitro [64, 95, 123, 124]. Contrastingly, removal of S. aureus by UVB is known to be quite successful [125]. An exciting new strategy in AE management could also be an anti-S. aureus vaccine [126].