Implementation
Worldwide, one third of the population suffers from a skin condition at some point in their lives (1). Several studies have suggested that imbalance in skin microbiota plays a role in a variety of skin diseases, including in eczema, acne vulgaris, rosacea and atopic dermatitis (2, 3, 4). Additionally, a skin microbiota dysbiosis can affect wound healing, e.g. by leading to chronic wounds (5). Generally, it is difficult to establish this imbalance. Many of the diseases associated with the skin are not correlated to microbiota yet, which is why doctors do not look in this area for treatment. The fact that exact numbers on how many people experience imbalances in skin microbiota are not known, indicates how valuable a rapid test would be in the context of establishing knowledge in this area.
This is why we are developing MIKROSKIN: a rapid test to identify bacterial strains present on the skin and to determine which percentage of the total skin microbiota they constitute. By targeting S. aureus and C. acnes, imbalances in which are commonly associated with atopic dermatitis and acne, respectively, a possible link could be examined. We have created a first prototype of our MIKROSKIN kit. Each kit contains the following items: a 96 well plate which contains solutions of different aptamers, an indicator strip, some swabs, an extraction tube with a buffer solution, an extraction tube holder as well as a user manual. Once samples are taken and drops of the content into the desired well. When specific bacteria is present on the skin, it will bind to the specific aptamer, inducing a colour change from blue to red, where red indicates presence of the bacteria. The range can be read off the indicator strip. A detailed plan on how to market MIKROSKIN can be found here.
Figure 1: Prototype of our MIKROSKIN kit
The need of bridging the existing knowledge gap between our skin and its inhabitants was also brought up during one of our interviews with the Dermatological Research Group at University Of Szeged (read more about the interview here). MIKROSKIN is therefore primarily meant as a tool for researchers as knowledge in the field of skin microbiota is limited. With MIKROSKIN, we aim to find a link between the abundance of various bacteria on the skin and several skin conditions.
We first expect to build the MIKROSKIN database. The aim of this database is to map different abundances of skin bacteria. This mapping will be done in collaboration with the first users of MIKROSKIN, i.e. research groups and skincare companies, who will submit data yielded from their samples. To ensure patient security this data will be anonymized with our DERMID solution. In this way we will not handle personal data, and GDPR will not apply. Read more about the ethics of our database in our ethics workplan.
After sufficient mapping of unhealthy and healthy abundances of different skin bacteria MIKROSKIN can be equipped with a more complex set of aptamers, to allow for testing of a broader range of bacterial species commonly seen to be imbalanced in skin disorders. Additionally, there is the ability to add aptamers specific for antibiotic resistance to the test which means only one test would be necessary to research imbalances common in a range of skin diseases. In this way, MIKROSKIN has the potential to serve as a high-throughput test with which the skin can be scanned for unhealthy abundances. MIKROSKIN can also be used as a customizable test suitable for detection of an antibiotic resistant species prior to antibiotic treatment or for assessing if a particular pro- or prebiotic targeting certain bacterial species will benefit the user.
If a correlation between certain bacterial imbalances and skin conditions is found through the MIKROSKIN database, our test has the potential to be useful to not only researchers, but also to individual patients - as a rapid test which can be done at home. The need for this became evident in our own conducted survey, where 69% of questioned people stated that it would personally help them if they knew that their skin problems might be due to imbalance in skin microbiota, and 71% stated that they would use a quick test for detection of microbial imbalance. Find more information on our survey here. A rapid skin test would make information on the current state of health easily available for customers at any location - outside of research purposes - and paves the way to personalised treatment options.
Figure 2: Excerpt from our Skin Microbiota survey
Figure 3: Excerpt from our Skin Microbiota survey
Implementation in the real world also includes an app for collected data on skin microbiota. We were thinking of achieving this through collaboration with skin care brands which for example already offer educational content to customers. This would be the first step towards a holistic and personalized approach to skin care: personal information derived from the test can be coupled to the development of personalized pro- or prebiotics. However, this poses safety questions in regards to collecting personal data from customers. In this case, a slightly less personalized route could be taken which requires less data, thus making it easier to store the data and preventing data leakage.
Another challenge of the project includes the possibility that no sufficient link between an imbalance in skin microbiota and skin conditions can be found. In that case, it would not make sense to offer such a test to individual customers as a test not linked to a cause, and subsequently to a treatment, is only of little value. However, in that case MIKROSKIN would still be a useful tool for researchers, as stated by Prof. and Dermatologist Lajos Kemeny and Dr. Szabo Kornelia of the Dermatological Research Group at University Of Szeged during our interview, and has the potential to advance knowledge in the field of both skin microbiota and aptamers - a field not widely studied as of now.
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Sources
Dagnelie MA, Montassier E, Khammari A, Mounier C, Corvec S, et al. Inflammatory skin is associated with changes in the skin microbiota composition on the back of severe acne patients. Exp Dermatol. 2019 Aug;28(8):961-967. Epub 2019 Jul 3.
Ying L, Shan W, Wankui D, Yuan L, Chunping S, et al. Distinct Skin Microbiota Imbalance and Responses to Clinical Treatment in Children With Atopic Dermatitis. Front in Cell and Infect Microbiology. 2020;10:336.
Murillo N, Raoult D. Skin microbiota: overview and role in the skin diseases acne vulgaris and rosacea. Fut Microbio. 2013;8(2).
Williams MR, Costa SK, Zaramela LS, Khalil S, Todd DA, et al. Quorum sensing between bacterial species on the skin protects against epidermal injury in atopic dermatitis. Sci Trans Med. 2019 May;11(490):eaat8329.
Tomic-Canic M, Burgess JL, O’Neill KE, Strbo N, Pastar I. Skin microbiota and its interplay with wound healing. Am J Clin Dermatol. 2020;21:36-43.