Skin microbiota and its role in health and disease with an emphasis on wound healing and chronic wound development

The skin has evolved into a protective barrier to enable the body to withstand physical, chemical, and biological assaults from pathogens. When the skin is compromised, the body activates the highly complex process of cutaneous wound healing to quickly close the wound, eliminate invading microbes, and strengthen the damaged area to restore the protective functions of the skin. Investigations using high-throughput sequencing platforms have begun to study the complex and diverse communities of microbes on the skin, known as the skin microbiota. The skin microbiota consists of trillion of microbes across bacterial, viral, and fungal families with different communities colonizing different locations of the body. The unique genetic, metabolic, and proteomic profiles of each microbial community may affect health, disease, and infection on the skin. How host-microbe interactions support healthy skin and wound healing is an urgent topic of research because dysbiosis, that is, perturbations to the skin microbiota, may result in the development of human skin diseases and ailments, including the development of chronic wounds. Studies have now shown that skin ailments such as atopic dermatitis, acne vulgaris, rosacea, psoriasis and even some skin cancers have skin microbiota different from normal skin. While common wound pathogens of chronic wounds have been identified through culture-dependent methods, it is now appreciated that the community of biofilm-forming microbes differs with some uniqueness across different types of wounds, such as venous ulcers, pressure ulcers, and diabetic foot ulcers. Understanding how specific skin microbes play an important role in wound healing and the overall health of the skin may lead to the next generation of therapeutics in which the skin microbiota is manipulated through probiotics, prebiotics, and skin microbiota transplants to prevent and treat skin ailments and chronic wounds.