SUMMARYAtopic dermatitis (AD) is a prevalent chronic inflammatory skin disorder, affecting 10%-20% of the population, characterized by dryness, intense itching, and recurrent rashes. The pathophysiology of AD is multifactorial, involving skin barrier dysfunction, immune dysregulation, genetic factors (such as filaggrin mutations), and environmental factors. The skin microbiota also plays a pivotal role in AD, serving both as a target and a driver of the disease. In AD, the delicate balance of the skin microbiota is disrupted, leading to a decrease in beneficial bacteria such as Streptococcus, Cutibacterium, and Corynebacterium. Concurrently, bacterial pathobionts, notably Staphylococcus aureus, proliferate and express their virulence factors excessively. This imbalance exacerbates symptoms by damaging the skin barrier, releasing toxins, and triggering a Th2-driven immune response, thus weakening the skin defenses and making individuals with AD more susceptible to bacterial, fungal, and viral infections, thereby complicating treatment and worsening disease outcomes. Effective AD management requires a thorough understanding of the interplay among the skin microbiota, the immune system, and microbial pathobionts. Strategies that restore the microbial balance, preserve the skin barrier, and modulate the immune response show significant potential for reducing infections and improving AD symptoms, highlighting the microbiota's dual role in AD pathology. This review examines the complex role of the skin microbiota in AD, emphasizing how dysbiosis both drives disease progression and influences immune responses, and vice versa. It also explores emerging microbiota-targeted therapies aimed at improving disease outcomes.
SUMMARYPersons who inject drugs are at increased risk of bacterial and fungal injecting-related infections due to many physiological, societal, and structural factors. An estimated 15 million persons inject drugs worldwide, with recent increases in the burden of injecting-related infections. Acquisition of these infections has distinct pathophysiology and microbiology related to drug supply, drug composition, and the process of injecting. Clinical management of these infections is complicated by usual factors such as the need for source control and effective antibiotics, as well as the complex challenges faced by persons who inject drugs while in hospital. These challenges include drug withdrawal, difficult pain control related to opioid tolerance, stigma, discrimination, and lack of access to outpatient parenteral antibiotic therapy, which can lead to high rates of patient-directed discharge and non-completion of treatment with subsequent poor outcomes. This review seeks to provide an evidence-based summary of what is known about the risks, epidemiology, microbiology, and presentation of injecting-related bacterial and fungal infections, as well as provide recommendations for treatment, including pharmacological considerations, opportunistic screening, multidisciplinary team care, and approaches to outpatient therapy. It also provides insight into the medicolegal and ethical considerations of care for persons who inject drugs and a first-person perspective of someone with lived experience.
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