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Atopic dermatitis (AD) is a chronically relapsing skin disease that occurs most commonly during early infancy and childhood. It is a highly pruritic inflammatory skin disease that results from multiple factors such as genetic susceptibility as well as the environment. Although AD is frequently associated with a defective skin barrier, the mechanisms related to defects in the innate immune system, heightened immunologic responses to allergens and microbial antigens are not well established. Recent advances in sequencing technologies have revealed the diversity of microbes on the skin surface, which engages in active cross-talk that maintain barrier integrity and functional immunity. There are substantial microbiome studies to show this cross talk is altered in atopic dermatitis, that is to say, an impaired skin barrier, the skin microbial flora and imbalanced immunity can form a vicious cycle that leads to AD. Therefore, microbiome studies suggest that AD is a disorder of an altered host-microbial relationship with complicated pathophysiology. In this review, we will discuss the nature and role of the skin and gut flora in AD pathophysiology and the therapeutic implications of microbiome correction in AD.
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