The human skin microbiota is essential for maintaining homeostasis and ensuring barrier functions. Over the years, the characterization of its composition and taxonomic diversity has reached outstanding goals, with more than 10 million bacterial genes collected and cataloged. Nevertheless, the study of the skin microbiota presents specific challenges that need to be addressed in study design. Benchmarking procedures and reproducible and robust analysis workflows for increasing comparability among studies are required. For various reasons and because of specific technical problems, these issues have been investigated in gut microbiota studies, but they have been largely overlooked for skin microbiota. After a short description of the skin microbiota, the review tackles methodological aspects and their pitfalls, covering NGS approaches and high throughput culture-based techniques. Recent insights into the “core” and “transient” types of skin microbiota and how the manipulation of these communities can prevent or combat skin diseases are also covered. Finally, this review includes an overview of the main dermatological diseases, the changes in the microbiota composition associated with them, and the recommended skin sampling procedures. The last section focuses on topical and oral probiotics to improve and maintain skin health, considering their possible applications for skin diseases.

Bacterial populations inhabiting a variety of natural and human-associated niches have the ability to grow in the form of biofilms. A large part of pathological chronic conditions, and essentially all the bacterial infections associated with implanted medical devices or prosthetics, are caused by microorganisms embedded in a matrix made of polysaccharides, proteins, and nucleic acids. Biofilm infections are generally characterized by a slow onset, mild symptoms, tendency to chronicity, and refractory response to antibiotic therapy. Even though the molecular mechanisms responsible for resistance to antimicrobial agents and host defenses have been deeply clarified, effective means to fight biofilms are still required. Lactic acid bacteria (LAB), used as probiotics, are emerging as powerful weapons to prevent adhesion, biofilm formation, and control overgrowth of pathogens. Hence, using probiotics or their metabolites to quench and interrupt bacterial communication and aggregation, and to interfere with biofilm formation and stability, might represent a new frontier in clinical microbiology and a valid alternative to antibiotic therapies. This review summarizes the current knowledge on the experimental and therapeutic applications of LAB to interfere with biofilm formation or disrupt the stability of pathogenic biofilms.

Postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS) are the two main forms of functional dyspepsia (FD). Probiotics are a promising therapy for FD, but current data remains heterogeneous. This work aims to evaluate a probiotic combination of Lacticaseibacillus rhamnosus LR04 (DSM 16605), Lactiplantibacillus pentosus LPS01 (DSM 21980), Lactiplantibacillus plantarum LP01 (LMG P-21021), and Lactobacillus delbrueckii subsp. delbruekii LDD01 (DMS 22106), alone or together with other pharmacological therapies, for clinical improvement of symptoms associated with FD. Patients with FD were enrolled and divided into two groups: PDS and EPS. Probiotic alone or combined with prokinetics, antacids, or proton-pump-inhibitors were administered for 30 days. A progressive-score scale was used to evaluate symptoms in all patients at the beginning of the trial and at 15 days after the end of treatment. A cohort of 2676 patients were enrolled (1 357 with PDS; 1 319 with EPS). All patients showed significant improvements in dyspeptic symptoms following treatment. In patients with PDS, probiotic alone resulted in the lowest prevalence of symptoms following treatment, while patients with EPS showed no clear between-treatment differences. Dyspeptic symptoms were reduced following treatment in all patients.

A 50-year-old man, pentathlete and fond of salmon fishing, after returning from Alaska was referred to our Division for an erythematous and indolent lesion on the right thigh gradually enlarging from the right knee to the right rear and the buttock.The patient was clinically diagnosed with figurate erythema. Laboratory analysis demonstrated a moderate leukocytosis and hypergammaglobulinemia, accompanied by serological markers of past contact with noted EBV and CMV.A “punch” biopsy of the edge of the lesion showed a superficial and deep perivascular and interstitial infiltrate of lymphocytes, eosinophiles and a few plasma cells, consistent with a borrelial infection. Lyme serology (IFI) suggested a questionable borderline positivity; subsequent investigations by ELISA and Western Blot were both positive, leading to the diagnosis of erythema chronicum migrans in course of borreliosis.The diagnosis was further confirmed by positive PCR for Borrelia burgdorferi sensu lato. The erythema resolved after a 2-week doxycycline treatment (2x100 mg die). The amplification product (16S rDNA gene) obtained from skin biopsy was sequenced using standard ABI technology, and confirmed the identification of a member of B. burgdorferi sensu lato (sl) complex. Since this sequence was not useful to identify the genospecies, further studies were conducted employing a nested PCR targeted on the internal transcribed spacer (ITS) of B. burgdorferi, following a protocol previously described (1). The ITS sequence showed 100% identity with B. afzelii, a species not reported from North America, thus prompting us to conclude that the patient was not infected by B. afzelii during the fishing trip in Alaska.