Summary

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by immune dysregulation, skin barrier dysfunction, microbial imbalance, and environmental triggers. Increasing evidence highlights the central role of the skin microbiome, and particularly the overgrowth of Staphylococcus aureus, in disease onset and exacerbation. The holobiont theory supports the concept that interactions between host genetics and microbial communities contribute to AD pathogenesis.

Conventional therapies can positively influence cutaneous dysbiosis and promote microbial balance. “Emollients plus,” containing prebiotics and bacterial lysates such as Vitreoscilla filiformis and Aquaphilus dolomiae, may increase microbial diversity and reduce AD flares. Topical corticosteroids, calcineurin inhibitors, biologics such as dupilumab and tralokinumab, AHR agonists, and phototherapy have also demonstrated beneficial effects on microbiota composition, particularly through reduction of S. aureus colonization.

Innovative microbiome-targeted therapies are emerging, including probiotics, bacteriotherapy, phage therapy, antimicrobial peptides, quorum-sensing inhibitors, and topical ozone therapy. Preliminary studies suggest these approaches may restore microbial diversity and reduce inflammation, although evidence remains limited. Overall, modulation of the skin microbiome represents a promising complementary strategy for improving AD management and preventing disease exacerbation.

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Authors

Bianca Gragnoli - Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy

Pasquale Comberiati - Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy

Gianluca Mirra - Pediatric Allergology Unit, Department of Pediatric Medicine, S. Pietro Hospital Fatebenefratelli, Roma, Italy

Elena Galli - Pediatric Allergology Unit, Department of Pediatric Medicine, S.Pietro Hospital Fatebenefratelli, Roma, Italy;

Francesca Cipriani - Primary Care Pediatrics, AUSL Bologna, Italy

Giampaolo Ricci - Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy

Nunzia Maiello - Department of Woman, Child and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy

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Copyright (c) 2026 Italian Journal of Pediatric Allergy and Immunology

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Gragnoli, B., Comberiati, P., Mirra, G., Galli, E., Cipriani, F., Ricci, G., & Maiello, N. (2026). An overview on treatment strategies targeting on cutaneous dysbiosis in patients with Atopic Dermatitis. Italian Journal of Pediatric Allergy and Immunology, 40(3). https://doi.org/10.53151/2531-3916/2026-2611
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