Chronic inflammatory cutaneous diseases, such as atopic dermatitis (AD) and psoriasis, are complex disorders influenced by immune dysregulation, various genetic factors, and more recently identified alterations within the skin microbiome. Among the skin’s commensal organisms, Malassezia species play a significant role in modulating both skin inflammation and barrier function. These fungi are normally harmless; becoming pathogenic under specific immune or environmental conditions is one of the proposed mechanisms of disease exacerbation. Recent advances in treatment, with biologic agents and smaller molecule therapies, have revolutionized disease management by precisely targeting certain immune pathways (IL-4, IL-13, IL-17, IL-23, and JAK-STAT cascade) being the primary focus of these interventions. The subsequent effects that such targeted therapies have on the skin microbiome itself, Malassezia included, are yet to be fully understood. Emerging evidence points towards biologics and/or novel treatments altering the local immune environment and to some degree skin barrier integrity, which in turn affects microbial composition and activity. This review details the current knowledge of Malassezia distribution and behavior in AD and psoriasis patients, their immune interactions, and potential impact of the novel therapies on malassezia. Personalized, microbiome conscious, therapeutic approaches are the end goal, improving treatment outcome and long term skin health in patients with chronic inflammatory skin disease.
Cite this paper
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