THE INFLUENCE OF SKIN MICROBIOME IMBALANCE ON SPECIFIC PATHOLOGICAL SKIN CONDITIONS

Michał Wycik; Hubert Chmielewski; Julia Komar; Artur Wądołowski; Gabriela Kondratiuk; Ada Kondrat; Michał Szczupak; Paweł Mierzejewski; Justyna Werno; Zuzanna Twarowska

doi:10.31435/ijitss.4(48).2025.4364

Authors

Michał Wycik University Clinical Hospital in Białystok, Białystok, Poland https://orcid.org/0009-0007-3052-9924
Hubert Chmielewski Medical University of Białystok, Białystok, Poland https://orcid.org/0009-0000-5697-518X
Julia Komar Medical University of Białystok, Białystok, Poland https://orcid.org/0009-0008-9104-7934
Artur Wądołowski University Clinical Hospital in Białystok, Białystok, Poland https://orcid.org/0009-0006-0261-581X
Gabriela Kondratiuk Medical University of Białystok, Białystok, Poland https://orcid.org/0009-0009-4181-731X
Ada Kondrat University Clinical Hospital in Białystok, Białystok, Poland https://orcid.org/0009-0008-0823-0544
Michał Szczupak University Clinical Hospital in Białystok, Białystok, Poland https://orcid.org/0009-0005-5112-6978
Paweł Mierzejewski University Clinical Hospital in Białystok, Białystok, Poland https://orcid.org/0009-0009-2004-9972
Justyna Werno University of Zielona Góra, Zielona Góra, Poland https://orcid.org/0009-0002-9681-3323
Zuzanna Twarowska University Clinical Hospital in Białystok, Białystok, Poland https://orcid.org/0009-0006-8662-099X

DOI:

https://doi.org/10.31435/ijitss.4(48).2025.4364

Keywords:

Skin Microbiome, Dysbiosis, Atopic Dermatitis, Psoriasis, Acne, Rosacea, Skin Cancer, Wound Healing, Microbiome Therapeutics, Microbial Imbalance

Abstract

The human skin microbiome, comprising bacteria, fungi, viruses, and other microorganisms, plays a crucial role in maintaining skin homeostasis, modulating immune responses, and protecting against pathogens. Emerging research highlights that disruptions in microbial balance - dysbiosis - contribute to the pathogenesis of various dermatological conditions, including atopic dermatitis, psoriasis, acne vulgaris, rosacea, skin cancer, and impaired wound healing. Dysbiosis arises from genetic, environmental, and therapeutic factors, leading to altered barrier function, chronic inflammation, and disease exacerbation.

In inflammatory disorders like atopic dermatitis and psoriasis, pathogenic overgrowth (e.g., Staphylococcus aureus) and reduced microbial diversity drive immune dysregulation. Similarly, acne and rosacea are influenced by shifts in Cutibacterium acnes phylotypes and Demodex-associated bacteria, which promote inflammation and biofilm formation. The skin microbiome also impacts skin cancer progression by modulating DNA damage responses and immunotherapy efficacy, while chronic wounds exhibit delayed healing due to pathogenic dominance and biofilm persistence.

Understanding the intricate host-microbiome interplay offers transformative potential for dermatology, paving the way for precision medicine interventions that harness microbial ecology to enhance skin health and treat disease.

References

Smythe, P., & Wilkinson, H. N. (2023). The skin microbiome: Current landscape and future opportunities. International Journal of Molecular Sciences, 24(4), 3950. https://doi.org/10.3390/ijms24043950

Schommer, N. N., & Gallo, R. L. (2013). Structure and function of the human skin microbiome. Trends in Microbiology, 21(12), 660. https://doi.org/10.1016/j.tim.2013.10.001

Prescott, S. L., et al. (2017). The skin microbiome: Impact of modern environments on skin ecology, barrier integrity, and systemic immune programming. World Allergy Organization Journal, 10(1), 29. https://doi.org/10.1186/s40413-017-0160-5

Sroka-Tomaszewska, J., & Trzeciak, M. (2021). Molecular mechanisms of atopic dermatitis pathogenesis. International Journal of Molecular Sciences, 22(8), 4130. https://doi.org/10.3390/ijms22084130

Schuler, C. F., Billi, A. C., Maverakis, E., Tsoi, L. C., & Gudjonsson, J. E. (2022). Novel insights into atopic dermatitis. Journal of Allergy and Clinical Immunology, 151(5), 1145. https://doi.org/10.1016/j.jaci.2022.10.023

Kennedy, E. A., et al. (2017). Skin microbiome before development of atopic dermatitis: Early colonization with commensal staphylococci at 2 months is associated with a lower risk of atopic dermatitis at 1 year. Journal of Allergy and Clinical Immunology, 139(1), 166. https://doi.org/10.1016/j.jaci.2016.07.029

The skin microbiome: Is there a role in the pathogenesis of atopic dermatitis and psoriasis? (2025, April 26). Journal of Drugs in Dermatology. https://jddonline.com/articles/the-skin-microbiome-is-there-a-role-in-the-pathogenesis-of-atopic-dermatitis-and-psoriasis-S1545961615P0127X/

Kobayashi, T., et al. (2015). Dysbiosis and Staphylococcus aureus colonization drives inflammation in atopic dermatitis. Immunity, 42(4), 756. https://doi.org/10.1016/j.immuni.2015.03.014

Lee, S. Y., Lee, E., Park, Y. M., & Hong, S. J. (2018). Microbiome in the gut–skin axis in atopic dermatitis. Allergy, Asthma & Immunology Research, 10(4), 354. https://doi.org/10.4168/aair.2018.10.4.354

Park, D. H., Kim, J. W., Park, H. J., & Hahm, D. H. (2021). Comparative analysis of the microbiome across the gut–skin axis in atopic dermatitis. International Journal of Molecular Sciences, 22(8), 4228. https://doi.org/10.3390/ijms22084228

Carmona-Cruz, S., Orozco-Covarrubias, L., & Sáez-de-Ocariz, M. (2022). The human skin microbiome in selected cutaneous diseases. Frontiers in Cellular and Infection Microbiology, 12, 834135. https://doi.org/10.3389/fcimb.2022.834135

Lee, H. J., & Kim, M. (2022). Skin barrier function and the microbiome. International Journal of Molecular Sciences, 23(21), 13071. https://doi.org/10.3390/ijms232113071

Edslev, S. M., Agner, T., & Andersen, P. S. (2020). Skin microbiome in atopic dermatitis. Acta Dermato-Venereologica, 100(12), 5769. https://doi.org/10.2340/00015555-3514

Koh, L. F., Ong, R. Y., & Common, J. E. (2022). Skin microbiome of atopic dermatitis. Allergology International, 71(1), 31–39. https://doi.org/10.1016/j.alit.2021.11.001

Tham, E. H., Chia, M., Riggioni, C., Nagarajan, N., Common, J. E. A., & Kong, H. H. (2024). The skin microbiome in pediatric atopic dermatitis and food allergy. Allergy, 79(6), 1470–1484. https://doi.org/10.1111/all.16044

Moniaga, C. S., Tominaga, M., & Takamori, K. (2022). An altered skin and gut microbiota are involved in the modulation of itch in atopic dermatitis. Cells, 11(23), 3930. https://doi.org/10.3390/cells11233930

Zhang, X. E., et al. (2024). Microbiome: Role in inflammatory skin diseases. Journal of Inflammation Research, 17, 1057. https://doi.org/10.2147/jir.s441100

Paller, A. S., et al. (2018). The microbiome in patients with atopic dermatitis. Journal of Allergy and Clinical Immunology, 143(1), 26. https://doi.org/10.1016/j.jaci.2018.11.015

Orsmond, A., Bereza-Malcolm, L., Lynch, T., March, L., & Xue, M. (2021). Skin barrier dysregulation in psoriasis. International Journal of Molecular Sciences, 22(19), 10841. https://doi.org/10.3390/ijms221910841

Petit, R. G., et al. (2021). Psoriasis: From pathogenesis to pharmacological and nano-technological-based therapeutics. International Journal of Molecular Sciences, 22(9), 4983. https://doi.org/10.3390/ijms22094983

Raharja, A., Mahil, S. K., & Barker, J. N. (2021). Psoriasis: A brief overview. Clinical Medicine, 21(3), 170. https://doi.org/10.7861/clinmed.2021-0257

Canal-García, E., Bosch-Amate, X., Belinchón, I., & Puig, L. (2022). Nail psoriasis. Actas Dermo-Sifiliográficas, 113(5), T481–T490. https://doi.org/10.1016/j.ad.2022.01.032

Ito, Y., & Amagai, M. (2022). Controlling skin microbiome as a new bacteriotherapy for inflammatory skin diseases. Inflammation and Regeneration, 42(1). https://doi.org/10.1186/s41232-022-00212-y

Buhaș, M. C., et al. (2022). Gut microbiota in psoriasis. Nutrients, 14(14), 2970. https://doi.org/10.3390/nu14142970

Gallo, R. L., & Nakatsuji, T. (2011). Microbial symbiosis with the innate immune defense system of the skin. Journal of Investigative Dermatology, 131(10), 1974. https://doi.org/10.1038/jid.2011.182

Celoria, V., et al. (2023). The skin microbiome and its role in psoriasis: A review. Psoriasis: Targets and Therapy, 13, 71. https://doi.org/10.2147/ptt.s328439

Cogen, A. L., Nizet, V., & Gallo, R. L. (2008). Skin microbiota: A source of disease or defence? British Journal of Dermatology, 158(3), 442. https://doi.org/10.1111/j.1365-2133.2008.08437.x

Thye, A. Y. K., et al. (2022). Gut–skin axis: Unravelling the connection between the gut microbiome and psoriasis. Biomedicines, 10(5), 1037. https://doi.org/10.3390/biomedicines10051037

Olejniczak-Staruch, I., et al. (2021). Alterations of the skin and gut microbiome in psoriasis and psoriatic arthritis. International Journal of Molecular Sciences, 22(8), 3998. https://doi.org/10.3390/ijms22083998

Arya, P., Kaur, M., Chosyang, S., Kushwaha, N., & Singh, B. (2023). Decrypting skin microbiome in psoriasis: Current status. Journal of Psoriasis and Psoriatic Arthritis, 8(4), 166. https://doi.org/10.1177/24755303231194293

Mazur, M., Tomczak, H., Lodyga, M., Czajkowski, R., Zaba, R., & Adamski, Z. (2021). The microbiome of the human skin and its variability in psoriasis and atopic dermatitis. Advances in Dermatology and Allergology, 38(2), 205. https://doi.org/10.5114/ada.2021.106197

Dréno, B., Dagnelie, M. A., Khammari, A., & Corvec, S. (2020). The skin microbiome: A new actor in inflammatory acne. American Journal of Clinical Dermatology, 21(Suppl 1), 18. https://doi.org/10.1007/s40257-020-00531-1

Natarelli, N., Gahoonia, N., & Sivamani, R. K. (2023). Bacteriophages and the microbiome in dermatology: The role of the phageome and a potential therapeutic strategy. International Journal of Molecular Sciences, 24(3), 2695. https://doi.org/10.3390/ijms24032695

Sánchez-Pellicer, P., et al. (2022). Acne, microbiome, and probiotics: The gut–skin axis. Microorganisms, 10(7), 1303. https://doi.org/10.3390/microorganisms10071303

Zhu, W., Hamblin, M. R., & Wen, X. (2023). Role of the skin microbiota and intestinal microbiome in rosacea. Frontiers in Microbiology, 14, 1108661. https://doi.org/10.3389/fmicb.2023.1108661

Severn, M. M., & Horswill, A. R. (2022). Staphylococcus epidermidis and its dual lifestyle in skin health and infection. Nature Reviews Microbiology, 21(2), 97. https://doi.org/10.1038/s41579-022-00780-3

El-Sayed, A., Aleya, L., & Kamel, M. (2021). Microbiota’s role in health and diseases. Environmental Science and Pollution Research, 28(28), 36967. https://doi.org/10.1007/s11356-021-14593-z

Xu, H., & Li, H. (2019). Acne, the skin microbiome, and antibiotic treatment. American Journal of Clinical Dermatology, 20(3), 335. https://doi.org/10.1007/s40257-018-00417-3

Ryguła, I., Pikiewicz, W., & Kaminiów, K. (2024). Impact of diet and nutrition in patients with acne vulgaris. Nutrients, 16(10), 1476. https://doi.org/10.3390/nu16101476

Mahmud, M. R., et al. (2022). Impact of gut microbiome on skin health: Gut–skin axis observed through the lenses of therapeutics and skin diseases. Gut Microbes, 14(1), 2096995. https://doi.org/10.1080/19490976.2022.2096995

Manos, J. (2022). The human microbiome in disease and pathology. APMIS, 130(12), 690. https://doi.org/10.1111/apm.13225

Jin, Z., Song, Y., & He, L. (2023). A review of skin immune processes in acne. Frontiers in Immunology, 14, 1324930. https://doi.org/10.3389/fimmu.2023.1324930

Kang, D., Shi, B., Erfe, M. C., Craft, N., & Li, H. (2015). Vitamin B12 modulates the transcriptome of the skin microbiota in acne pathogenesis. Science Translational Medicine, 7(293), 293ra103. https://doi.org/10.1126/scitranslmed.aab2009

Huang, C., et al. (2023). The updates and implications of cutaneous microbiota in acne. Cell & Bioscience, 13(1), 113. https://doi.org/10.1186/s13578-023-01072-w

Lam, M., Hu, A., Fleming, P., & Lynde, C. W. (2022). The impact of acne treatment on skin bacterial microbiota: A systematic review. Journal of Cutaneous Medicine and Surgery, 26(1), 93–97. https://doi.org/10.1177/12034754211037994

Chilicka, K., Dzieńdziora-Urbińska, I., Szyguła, R., Asanova, B., & Nowicka, D. (2022). Microbiome and probiotics in acne vulgaris: A narrative review. Life, 12(3), 422. https://doi.org/10.3390/life12030422

Yang, Y., Qu, L., Mijakovic, I., & Wei, Y. (2022). Advances in the human skin microbiota and its roles in cutaneous diseases. Microbial Cell Factories, 21(1), 176. https://doi.org/10.1186/s12934-022-01901-6

Dreno, B., et al. (2024). Acne microbiome: From phyla to phylotypes. Journal of the European Academy of Dermatology and Venereology, 38(4), 657–664. https://doi.org/10.1111/jdv.19540

Sánchez-Pellicer, P., et al. (2024). Rosacea, microbiome and probiotics: The gut–skin axis. Frontiers in Microbiology, 14, 1323644. https://doi.org/10.3389/fmicb.2023.1323644

Xiao, X., et al. (2023). The role of short-chain fatty acids in inflammatory skin diseases. Frontiers in Microbiology, 13, 1083432. https://doi.org/10.3389/fmicb.2022.1083432

Dreno, B., Martin, R., Moyal, D., Henley, J. B., Khammari, A., & Seité, S. (2017). Skin microbiome and acne vulgaris: Staphylococcus, a new actor in acne. Experimental Dermatology, 26(9), 798–803. https://doi.org/10.1111/exd.13296

Morgenroth, S., Roggo, A., Pawlik, L., Dummer, R., & Ramelyte, E. (2023). What is new in cutaneous T-cell lymphoma? Current Oncology Reports, 25(11), 1397. https://doi.org/10.1007/s11912-023-01464-8

Woo, Y. R., Cho, S. H., Lee, J. D., & Kim, H. S. (2022). The human microbiota and skin cancer. International Journal of Molecular Sciences, 23(3), 1813. https://doi.org/10.3390/ijms23031813

Azzimonti, B., et al. (2023). Microbiota, oxidative stress, and skin cancer: An unexpected triangle. Antioxidants, 12(3), 546. https://doi.org/10.3390/antiox12030546

Hou, K., et al. (2022). Microbiota in health and diseases. Signal Transduction and Targeted Therapy, 7(1), 135. https://doi.org/10.1038/s41392-022-00974-4

Chambers, E. S., & Vukmanovic-Stejic, M. (2019). Skin barrier immunity and ageing. Immunology, 160(2), 116. https://doi.org/10.1111/imm.13152

De Pessemier, B., Grine, L., Debaere, M., Maes, A., Paetzold, B., & Callewaert, C. (2021). Gut–skin axis: Current knowledge of the interrelationship between microbial dysbiosis and skin conditions. Microorganisms, 9(2), 353. https://doi.org/10.3390/microorganisms9020353

Flowers, L., & Grice, E. A. (2020). The skin microbiota: Balancing risk and reward. Cell Host & Microbe, 28(2), 190. https://doi.org/10.1016/j.chom.2020.06.017

Zhu, Y., Yu, X., & Cheng, G. (2023). Human skin bacterial microbiota homeostasis: A delicate balance between health and disease. mLife, 2(2), 107. https://doi.org/10.1002/mlf2.12064

Pereira, M. S., Redanz, S., & Kriegel, M. A. (2022). Skin deep: The role of the microbiota in cutaneous autoimmunity. Journal of Investigative Dermatology, 142(3), 834–840. https://doi.org/10.1016/j.jid.2021.12.005

Yang, Y., Huang, J., Zeng, A., Long, X., Yu, N., & Wang, X. (2024). The role of the skin microbiome in wound healing. Burns & Trauma, 12, tkad059. https://doi.org/10.1093/burnst/tkad059

Fernandes, A., Rodrigues, P. M., Pintado, M., & Tavaria, F. K. (2023). A systematic review of natural products for skin applications: Targeting inflammation, wound healing, and photo-aging. Phytomedicine, 115, 154824. https://doi.org/10.1016/j.phymed.2023.154824

Tomic-Canic, M., Burgess, J. L., O’Neill, K. E., Strbo, N., & Pastar, I. (2020). Skin microbiota and its interplay with wound healing. American Journal of Clinical Dermatology, 21(Suppl 1), 36. https://doi.org/10.1007/s40257-020-00536-w

Canchy, L., Kerob, D., Demessant, A., & Amici, J. M. (2023). Wound healing and microbiome: An unexpected relationship. Journal of the European Academy of Dermatology and Venereology, 37(S3), 7–15. https://doi.org/10.1111/jdv.18854

Wang, G., et al. (2021). Bacteria induce skin regeneration via IL-1β signaling. Cell Host & Microbe, 29(5), 777. https://doi.org/10.1016/j.chom.2021.03.003

Swaney, M. H., & Kalan, L. R. (2021). Living in your skin: Microbes, molecules, and mechanisms. Infection and Immunity, 89(4), e00695-20. https://doi.org/10.1128/iai.00695-20

Piazzesi, A., Scanu, M., Ciprandi, G., & Putignani, L. (2024). Modulations of the skin microbiome in skin disorders: A narrative review from a wound care perspective. International Wound Journal, 21(10), e70087. https://doi.org/10.1111/iwj.70087

Li, C., et al. (2022). Insights on gut and skin wound microbiome in stranded Indo-Pacific finless porpoise (Neophocaena phocaenoides). Microorganisms, 10(7), 1295. https://doi.org/10.3390/microorganisms10071295

Wang, G., et al. (2023). Commensal microbiome promotes hair follicle regeneration by inducing keratinocyte HIF-1α signaling and glutamine metabolism. Science Advances, 9(1), eabo7555. https://doi.org/10.1126/sciadv.abo7555

White, E. K., & Grice, E. A. (2023). The wound microbiome. Cold Spring Harbor Perspectives in Biology, 15(6), a041218. https://doi.org/10.1101/cshperspect.a041218