This study investigates the therapeutic potential of microbiome-targeted interventions for moderate-to-severe atopic dermatitis through a comprehensive clinical trial evaluating both skin and gut microbiome modulation. The randomized controlled study compared three treatment approaches: oral probiotic supplementation, topical application of commensal skin bacteria, and a combination of both therapies, against standard care in 65 patients over 12 weeks. Clinical assessments demonstrated superior efficacy of combination therapy, with a 64.7 percent reduction in disease severity scores compared to 37.5 percent in controls. Microbiome analysis revealed significant ecological shifts, including a 4.7-fold reduction in pathogenic Staphylococcus aureus colonization and a 3.2-fold increase in protective commensal bacteria following topical treatment. Probiotic administration substantially increased beneficial Bifidobacterium abundance in the gut microbiota while elevating fecal butyrate levels by 91.5 percent. Immunological profiling showed parallel improvements in barrier function and systemic inflammation markers, with combination therapy producing the most pronounced effects. Excellent safety was demonstrated by the treatment; no significant side effects were noted. According to these results, modifying the cutaneous and intestinal microbiomes at the same time can produce clinically significant benefits that go beyond those of traditional treatment alone. The study provides evidence for microbiome restoration as a viable therapeutic strategy in atopic dermatitis, offering potential advantages through disease-modifying mechanisms rather than temporary symptom suppression. Further research should focus on optimizing treatment protocols and investigating long-term outcomes of these innovative interventions.
