Russian Journal of AllergyRussian Journal of AllergyРоссийский Аллергологический Журнал1810-88302686-682XPublishing House ABV Press149610.36691/RJA1496ReviewsНаучные обзорыReview ArticleAltered skin microbiome: The most important symptom of atopic dermatitisИзменённый микробиом кожи ― важнейший признак атопического дерматитаhttps://orcid.org/0000-0003-3261-67185476-8497TamrazovaOlga B.ТамразоваОльга Борисовна
Russian Federation

MD, Dr. Sci. (Med), Professor

д.м.н., профессор

anait_tamrazova@mail.ruhttps://orcid.org/0000-0002-3004-6646GlukhovaEvgeniya A.ГлуховаЕвгения Александровна
Russian Federation
evgeniya.shmeleva1994@yandex.ruhttps://orcid.org/0000-0002-4672-697X1563-1190TamrazovaAnait V.ТамразоваАнаит Вардановна
Russian Federation

anaittamrazova@gmail.comhttps://orcid.org/0000-0003-3278-47973677-5969DubovetsNatalia F.ДубовецНаталия Федоровна
Russian Federation
skorpionka_n@mail.ruMoscow’s Healthcare Department Children Hospital of Z.A. BashlyaevaДетская городская клиническая больница имени З.А. Башляевой Департамента здравоохранения города МосквыPeoples’ Friendship University of RussiaРоссийский университет дружбы народовFederal Research Center of Nutrition and BiotechnologyФедеральный исследовательский центр питания, биотехнологии и безопасности пищиCentral State Medical Academy of Department of Presidential AffairsЦентральная государственная медицинская академия Управления делами Президента Российской ФедерацииKrasnogorsk Dermatovenerologic DispensaryКрасногорский кожно-венерологический диспансер22122021141220211841071150911202110122021Copyright ©; 2021, Pharmarus Print MediaCopyright ©; 2021, Фармарус Принт Медиа2021Pharmarus Print MediaФармарус Принт Медиаhttps://rusalljournal.ru/raj/article/view/1496

The progressively increased incidence of atopic dermatitis among children and increased persistence in adulthood, combined with an inevitably decreased quality of life of patients, determine the relevance of studying the development mechanisms of this disease not only for dermatology but also for the entire health care system. Thus, the prerequisites for the emergence of new pathogenetic concepts and the search for the most effective therapeutic modalities arise. Currently, atopic dermatitis is considered as the interaction of endogenous (impaired immune response and insufficient epidermal barrier function) and exogenous (exposure to allergens, chemical or physical irritants, and microorganisms) factors.

Environmental factors, such as temperature and humidity, genetic makeup, antibiotic use, and good hygiene, play a critical role in skin microbiome maintenance and stability. Normally, the skin microbiota is mainly formed by bacteria of the genus Staphylococcus, Propionibacterium, Corynebacterium, and Streptococcus. In 70% of patients with atopic dermatitis, colonization of Staphylococcus aureus is observed on the affected skin, whereas on the unaffected skin in 39%, which secondarily contributes to the development of immune imbalance and increased skin xerosis. This fact determines the importance of basic therapy, which, on one hand, helps to strengthen the epidermal barrier, and on the other, normalizes the microbiome of the skin, thereby reducing the colonization of Staphylococcus aureus.

The normal skin microbiome suppresses the activity of immune-inflammatory responses and regulates pH, lipid synthesis, and transepidermal water loss. Thus, skin microbiome normalization is the key to successful therapy and long-term remission of atopic dermatitis.

Прогрессирующий рост заболеваемости атопическим дерматитом среди детей, нарастание персистенции во взрослом возрасте при неизбежном снижении качества жизни пациентов обусловливают актуальность изучения механизмов развития данного заболевания не только для дерматологии, но и всего здравоохранения в целом. Таким образом, возникают предпосылки к появлению новых концепций патогенеза и поиска наиболее эффективных терапевтических возможностей. На данный момент атопический дерматит рассматривают как взаимодействие эндогенных (нарушенный иммунный ответ, недостаточность функции эпидермального барьера) и экзогенных (воздействие аллергенов, химических или физических раздражителей, микроорганизмы) факторов.

Факторы окружающей среды, такие как температура и влажность, генетические особенности организма, использование антибиотиков и соблюдение гигиены, играют решающую роль в поддержании и стабильности микробиома кожи. В норме микробиота кожного покрова образована в основном бактериями рода Staphylococcus, Propionibacterium, Corynebacterium и Streptococcus. У пациентов с атопическим дерматитом поражённая кожа колонизирована Staphylococcus aureus в 70% случаев, непоражённая кожа ― в 39%, что свидетельствует о вторичных причинах иммунного дисбаланса и усиления ксероза кожи. Данный факт обусловливает важность применения базовой терапии, которая, с одной стороны, способствует укреплению эпидермального барьера, с другой ― нормализует микробиом кожного покрова, снижая колонизацию золотистого стафилококка.

Нормальный микробиом кожи подавляет активность иммунных воспалительных реакций, регулирует pH, синтез липидов и транэпидермальную потерю воды. Таким образом, нормализация микробиома кожи является залогом успешной терапии и длительной ремиссии атопического дерматита.

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