Atopic Dermatitis and the Skin Microbiome: Understanding the Connection

Atopic dermatitis, commonly known as eczema, is a chronic skin condition that affects millions of people worldwide. While its exact cause remains unknown, recent research has shed light on the role of the skin microbiome in the development and management of atopic dermatitis. In this blog post, we will explore what the skin microbiome is, how its disruption can precede an atopic flare, the importance of emollients in restoring the skin’s barrier function, and why the use of topical antibiotics may harm the delicate balance of the microbiome.

Understanding the Skin Microbiome:

The skin microbiome refers to the community of microorganisms that reside on the surface of our skin. It consists of various bacteria, fungi, viruses, and other microorganisms. These microscopic inhabitants play a vital role in maintaining skin health by interacting with our immune system and providing a protective barrier against harmful pathogens.

Disruption in the Microbiome and Atopic Flares:

Research suggests that individuals with atopic dermatitis have an altered skin microbiome compared to those with healthy skin. This imbalance, known as dysbiosis, can manifest as a decrease in beneficial bacteria and an overgrowth of harmful microbes. The disruption of the skin microbiome can weaken the skin’s barrier function, making it more susceptible to allergens, irritants, and infections.

The Link Between Microbiome and Atopic Dermatitis:

Several studies have demonstrated that a disrupted skin microbiome often precedes an atopic flare. The decrease in beneficial bacteria, such as Staphylococcus epidermidis, and the increase in potentially pathogenic bacteria, like Staphylococcus aureus, have been observed in individuals with atopic dermatitis. This dysbiosis triggers an inflammatory response, leading to itchiness, redness, and the characteristic skin lesions associated with the condition.

Restoring the Barrier Function with Emollients:

One of the key strategies in managing atopic dermatitis is to restore the skin’s barrier function. Emollients, or moisturizers, play a crucial role in this process. By replenishing the skin’s natural moisture and lipid content, emollients help strengthen the skin barrier, reducing water loss and preventing the entry of irritants and allergens. Regular and proper application of emollients can help alleviate symptoms and reduce the frequency of atopic flares.

Topical Antibiotics and the Microbiome:

While antibiotics have been traditionally used to combat bacterial infections in atopic dermatitis, their long-term use can disrupt the delicate balance of the skin microbiome. Topical antibiotics not only target harmful bacteria but also eliminate beneficial bacteria, leading to further dysbiosis. This disruption may result in antibiotic resistance, increased susceptibility to infections, and potential exacerbation of atopic dermatitis symptoms. Thus, it is important to use antibiotics judiciously and under the guidance of a dermatologist.


Understanding the role of the skin microbiome in atopic dermatitis provides valuable insights into the development and management of this chronic condition. Maintaining a healthy balance of the skin microbiome is crucial for optimal skin health and reducing the frequency and severity of atopic flares. Emollients serve as an essential tool in restoring the skin barrier, while the use of topical antibiotics should be carefully considered to avoid further disruption. By incorporating these aspects into the management plan, dermatologists can provide holistic care to individuals with atopic dermatitis, promoting overall skin wellness.