{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:39:37Z","timestamp":1790667577264,"version":"4.1.0"},"reference-count":68,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>The pathogenesis of atopic dermatitis (AD) involves cutaneous barrier dysfunction, immune dysregulation, and microbiota imbalance. Although microbiota-directed therapeutic approaches have garnered increasing attention, current evidence is heterogeneous, encompassing probiotics, postbiotics, microbial metabolites, local microbial interventions, antimicrobials and ecological modulation strategies. This narrative review does not aim to provide clinical guidelines, but rather seeks to synthesise existing evidence within a three-tier conceptual framework. This framework classifies interventions into three categories: those primarily addressing local inflammation and barrier-associated microbiota dysbiosis; those exerting systemic immunomodulation via gut-derived microbial signals; and those modulating the skin microbiota ecology. It should be noted that human clinical data are still limited and heterogeneous, and much mechanistic insight is derived from preclinical research. By clarifying mechanistic layers and evidentiary gaps, this framework may facilitate future research to evaluate the sequencing or combination of anti-inflammatory therapy, barrier restoration, and microbiota ecological modulation.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1873455","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T06:05:24Z","timestamp":1784095524000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Microbiota-directed therapies for atopic dermatitis: a three-tier framework for inflammation control, immune modulation, and microbiome restoration"],"prefix":"10.3389","volume":"17","author":[{"given":"Yi","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Dermatology, The First Affiliated Hospital of Ningbo University","place":["Ningbo, China"]},{"name":"Faculty of Medicine, Ningbo University","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quan","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Dermatology, The First Affiliated Hospital of Ningbo University","place":["Ningbo, China"]},{"name":"Faculty of Medicine, Ningbo University","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guixiu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Dermatology, The First Affiliated Hospital of Ningbo University","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiongyan","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Dermatology, The First Affiliated Hospital of Ningbo University","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, The First Affiliated Hospital of Ningbo University","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoxia","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, The First Affiliated Hospital of Ningbo University","place":["Ningbo, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.5826\/dpc.1104a146","article-title":"Atopic dermatitis: Epidemiology and clinical phenotypes","volume":"11","author":"Raimondo","year":"2021","journal-title":"Dermatol Pract Concept"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.alit.2022.04.003","article-title":"Peripheral itch sensitization in atopic dermatitis","volume":"71","author":"Tominaga","year":"2022","journal-title":"Allergology Int"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3390\/ijms21082867","article-title":"Skin barrier abnormalities and immune dysfunction in atopic dermatitis","volume":"21","author":"Yang","year":"2020","journal-title":"IJMS"},{"key":"B4","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1007\/s12016-024-09004-3","article-title":"Neutrophils in atopic dermatitis","volume":"67","author":"Chiang","year":"2024","journal-title":"Clin Rev Allergy Immunol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1016\/j.abd.2024.06.001","article-title":"Update on the pathogenesis of atopic dermatitis","volume":"99","author":"Criado","year":"2024","journal-title":"Anais Brasileiros Dermatologia"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3390\/ijms241411380","article-title":"Challenges and future trends in atopic dermatitis","volume":"24","author":"Gatmaitan","year":"2023","journal-title":"IJMS"},{"key":"B7","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1016\/j.jaci.2025.02.029","article-title":"Endotypes of atopic dermatitis","volume":"156","author":"Fyhrquist","year":"2025","journal-title":"J Allergy Clin Immunol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1111\/all.16077","article-title":"Efficacy and safety of topical streptococcus postbiotic emollient in adolescents and adults with mild\u2010to\u2010moderate atopic dermatitis: A randomized, double\u2010blind, vehicle\u2010controlled trial","volume":"79","author":"Kim","year":"2024","journal-title":"Allergy"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.943640","article-title":"Atopic dermatitis: Is innate or adaptive immunity in control? 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