# Atopic dermatitis, primary atopic disorders, and the cutaneous microbiome: current understanding of an expanding field

## TL;DR

This paper reviews the current understanding of atopic dermatitis, its link to primary atopic disorders, and the role of the skin microbiome in disease progression and treatment.

## Contribution

The paper identifies gaps in knowledge regarding microbiome changes in primary atopic disorders.

## Key findings

- Primary atopic disorders are linked to immune dysregulation due to monogenic mutations.
- Dysbiosis in the cutaneous microbiome is a key factor in atopic dermatitis severity and potential triggers.
- There is limited understanding of how microbiome changes relate to primary atopic disorders.

## Abstract

Atopic dermatitis is a common inflammatory skin disease with rapidly expanding worldwide prevalence. Increasingly, cases of severe and early-onset dermatitis have been identified and found to be due to underlying monogenic mutations, leading to immune dysregulation. These conditions, called primary atopic disorders, have become an area of extensive study over the last 30 years. Simultaneously, our understanding of the human microbiome has steadily grown, and there is clear evidence that dysbiosis plays a major role in atopic dermatitis, not only in severity of disease and as a potential trigger but also offering clues for targeted treatment strategies. Unfortunately, despite our growing understanding of the cutaneous microbiome and the expanding availability of genetic testing allowing for diagnosis of primary atopic disorders, there remains very limited understanding regarding the microbiomics changes that underlie these disorders. Here we review the current research regarding atopic dermatitis in the setting of primary atopic disorders, understanding regarding primary atopic disorders and associated cutaneous dysbiosis, and identify specific gaps in knowledge.