Published Paper Details:

Background: Atopic dermatitis (AD) is a chronic inflammatory disease with increasing global prevalence and substantial socioeconomic burden. Traditionally explained by epidermal barrier defects and immune dysregulation, AD is now recognized as a systemic disorder influenced by the gut-skin axis, where alterations in the gut microbiome contribute to disease initiation and progression. Aim: This review synthesizes current evidence on the role of the gut microbiome in the pathogenesis of AD and evaluates microbiome-targeted management strategies including probiotics, prebiotics, synbiotics, dietary interventions, and fecal microbiota transplantation (FMT). Findings: Patients with AD exhibit gut dysbiosis characterized by reduced microbial diversity, depletion of short-chain fatty acid (SCFA)-producing taxa, and impaired tryptophan and bile acid metabolism. These microbial changes promote Th2/Th17-skewed immune responses, barrier dysfunction, and systemic inflammation. Preventive probiotic supplementation during pregnancy and infancy reduces AD risk by approximately 20%, particularly with Lactobacillus rhamnosus GG and Bifidobacterium breve. Treatment trials demonstrate modest, strain-specific improvements in clinical scores (SCORAD/EASI), though results remain inconsistent. Prebiotics and synbiotics show emerging potential, while postbiotic strategies remain experimental. Dietary interventions, especially Mediterranean-style diets and fermented foods, enhance microbial diversity and exert anti-inflammatory effects, whereas restrictive elimination diets without confirmed food allergies are discouraged. Early RCTs of capsule-based FMT in moderate-to-severe AD demonstrate clinically meaningful reductions in disease severity with good short-term safety. Conclusion: The gut microbiome plays a pivotal role in AD pathogenesis and represents a promising therapeutic target. While probiotics and dietary modulation offer safe, accessible adjuncts, FMT and postbiotics require further validation. Future research should focus on strain-specificinterventions, standardized biomarkers, long-term safety, and personalized microbiome profiling to enable precision medicine in AD management.