编者按：
皮肤微生物组对皮肤健康和外不雅具有主要影响。跟着微生物组研究的不竭深切，我们对皮肤微生物组有了更为深刻的领会，并开展了一系列的临床试验，以探讨包罗益生菌、益生元在内的微生物疗法对皮肤疾病的治疗感化。
今天，我们配合存眷皮肤微生物组。但愿本文可以或许为相关的财产人士和诸位读者带来一些开导和帮忙。
皮肤微生物组与疾病
近几十年来，因为不妥或错误的免疫反映，以及免疫调节收集的缺陷造当作的慢性炎症性疾病正在快速舒展。人们遍及认为是因为情况、糊口体例和饮食等身分的转变，导致免疫系统没有获得准确的或充实的练习而发生了这样的成果[1,2]。一些研究认为微生物多样性的降低，以及其他影响微生物代谢的身分也会显著影响免疫系统的耐受性[3]。
人体概况定植着多种微生物，这些微生物形当作了复杂的群落布局组织，并操纵来自于其他微生物或者宿本家儿的排泄物作为营养进行保存。现代糊口体例、药物治疗和社交互动的体例发生了翻天覆地的转变，从底子上影响了人类微生物组的群落布局，并导致免疫介导疾病的患病风险增添[4]。
宿世界列国有很多研究小组正在深切的研究这种联系紧密亲密且复杂的联系机制，以维持可以或许对宿本家儿的心理、代谢和免疫方面发生益处的不变情况。固然人体皮肤所表露的外界情况发生了转变，但人体皮肤正在积极地调节微生物的定植，以及调控微生物进入真皮或皮下组织。
微生物之间以及其与宿本家儿细胞（包罗角质形当作细胞和免疫细胞）之间彼此感化，使得皮肤情况趋于不变（图1）。皮肤微生物组对宿本家儿免疫功能的影响包罗促进宿本家儿防御病原体的收集，炎症的节制和顺应性免疫通路的构建[5,6]。共生皮肤微生物还可以直接按捺病原体和机遇性细菌的定植或入侵。例如，表皮葡萄球菌（皮肤中最丰硕的共生物种之一）可以刺激角质形当作细胞抗菌肽的发生，并在伤口愈合过程中按捺炎症细胞因子的释放和炎症的发生[7]。
跟着微生物组研究的不竭成长，曩昔十年里，颁发了很多评估益生菌和益生元干涉干与对皮肤病的疗效临床尝试研究，成果喜忧各半。
图1.皮肤上微生物和微生物之间以及微生物与宿本家儿细胞之间存在着复杂的彼此感化：皮肤和毛囊上的各类微生物彼此感化，从而按捺病原微生物的增殖。微生物经由过程排泄死菌素、自身诱导肽（AIPs），酚溶性调节卵白（PSMs）和环状抗微生物肽（AMPs）来影响其他微生物的发展。
人体临床试验成果分歧
益生菌对儿童异位性皮肤炎症（AD）的治疗潜能一向是研究的核心。很多随机对照试验（RCT）陈述称，在给患有异位性皮肤炎症的儿童口服益生菌后，疾病的严重水平和炎症标记物的品貌都有所降低[8-16]。某些大型的研究不雅察到，在产前和产后给母亲和婴儿口服益生菌弥补剂对预防儿童异位性皮肤炎症有着显著的结果[17-19]。
然而，另一些试验获得了相反的结论，口服益生菌和对照抚慰剂在预防或改善儿童异位性皮肤炎症的临床表示或炎症标记物方面并没有差别[20-27]。
多项研究评估了益生菌和益生元组合（合生制剂）对患有异位性皮肤炎症人群的结合感化，发现其可以降低疾病的严重水平[25,28]。然而，其他试验陈述发现，在异位性皮肤炎症人群中，这些合生制剂较着缺乏协同促进活性[29,30]。
口服益生菌干涉干与当作人痤疮的发生同样也获得了极大的存眷。一些试验已经证实了零丁利用益生菌或将益生菌与尺度治疗结合利用的疗法，都可以改善临床症状[31-33]。然而，一项试验陈述表白，零丁利用益生菌对干涉干与当作人痤疮几乎没有效处，可是当与潜在的益生元乳铁卵白连系利用时，会有显著的临床改善结果[34,35]。
比来的一些研究表白，口服益生菌对斑块状银屑病[36,37]、当作人异位性皮肤炎症[38]、手部皮炎[39]、丘疹脓疱性酒渣鼻、脂溢性皮炎[35]以及头皮屑[40]都有潜在的益处。
固然有很多研究调查了口服益生菌的临床潜力，可是评估局部利用益生菌和益生元对皮肤病的干涉干与影响试验比力少。
据报道，局部采用益生元治疗可以或许使得当作人和儿童的异位性皮肤炎症严重水平有所降低[41-43]。此外，这类干涉干与性研究还不雅察到金黄色葡萄球菌的定植有所削减。一项研究甚至表白，仅利用一次从人类皮肤共生体平分离获得的抗菌剂乳液后，患者的金黄色葡萄球菌品貌就会降低[44]。
对于当作人痤疮，一项 2 期临床试验陈述表白，利用局部益生菌喷雾可以或许显著降低痤疮的严重水平和炎症毁伤，固然这项研究还未被完整颁发[45]。还有研究发现，利用水包油包装的益生菌治疗后，人体的红斑和痤疮病变严重性下降，而且皮肤樊篱可以或许获得恢复[46]；另一项研究也报导了痤疮患者利用局部益生菌喷雾带来的皮肤相关改善[47]。此外，一项随机对照试验表白，单一菌株的益生菌乳膏可显著降低皮肤敏感度，并加强敏感肌女性的皮肤对化学和物理毁伤的抵当力[48]。
需要更深切的研究
固然有证据可以或许撑持将益生菌或益生元疗法用于治疗皮肤病，但研究成果间存在的差别限制了这一疗法的实施。研究成果间的差别可能是因为治疗方案，介入者统计、纳入和解除尺度以及利用单菌株或多菌株制剂等身分的分歧导致的。事实上，一项研究表白菌株的选择对治疗异位性皮肤炎症的治疗结果有主要影响[15]。
此外，很多研究存在样本量小、随访时候短等限制。很多疾病可能需要长时候的研究才能看到真实的成果。
尽管我们已经知道宿本家儿微生物组多样性和宿本家儿文化与遗传身分布景之间存在慎密的联系关系，可是只有很少一部门的研究公开了介入者的种族布景或皮肤类型，对于饮食这一身分的发布则更少[49]。
今朝，口服益生菌对儿童和当作人异位性皮肤炎症的影响和局部利用益生菌对痤疮以及儿童异位性皮肤炎症的影响的研究正在进行或处于招募中[50]。这些研究有望进一步说明益生菌干涉干与办法在皮肤病中的有用性。
近年来，我们在描述皮肤微生物组构成和其与皮肤炎症性疾病间的相关性上，取得了重大的进展。然而，我们对皮肤微生物组的理解仍然很有限，出格是对于皮肤微生物-宿本家儿间通信交流的功能根本的领会。此外，新的益生菌以及传统益生菌都应该进行需要的临床检测。不仅如斯，还应该查抄其他微生物当作分，包罗微生物代谢产品，以更好地摸索这些新型微生物疗法在病变部位的应用。
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更多内容，请阅读：
https://doi.org/10.1038/s41435-021-00133-9
作者｜Nonhlanhla Lunjani, Sinead Ahearn-Ford, Felix S. Dube, Carol Hlela 和 Liam O'Mahony
编译｜Suzj
