Microbiome-based diagnostics may soon play an important role in dermatology, says James Versalovic, MD, PhD, Director of the Texas Children’s Microbiome Center and Pathologist-in-Chief and Head at the Texas Children’s Hospital in Houston. He recently spoke about microbiome testing at the annual meeting of the College of American Pathologists in Orlando, FL.

The microbiome refers to the genetic material of all the microbes—bacteria, fungi, protozoa, and viruses—that live on and inside the human body. It was fully characterized a decade ago, and while there are still more questions than answers, scientists are getting closer and closer to understanding the role of the microbiome in both disease and health.

As it stands, microbiome-based analysis has made strides in certain specialties, such as gastroenterology. Today, gastroenterologists routinely analyze fecal samples to diagnose and monitor enteric infections and chronic conditions, such as irritable bowel syndrome and colitis.

In dermatology, researchers are starting to develop methodologies for skin sampling and DNA sequencing to determine which microbes are present.

“The dermatopathology and dermatology communities will need to work together to develop tests that look at skin pathology by biopsy and DNA sequencing,” Dr. Versalovic says. ”Looking at the microscopic and microbial cells on skin, in parallel can help establish a diagnosis.”

Of course, a big challenge will be to determine if these changes are the cause or result of disease.

“The question will become ‘What do changes in the skin microbiome mean in conjunction with pathology under the microscope?’,” he says. “Can we place one and one together to make two for a more accurate diagnosis of the skin condition?”

That is the hope, he asserts. A more accurate diagnosis may then lead to more effective, targeted treatments, he adds. “We may have to change ingredients in cleansers and soaps once we get a clearer picture of the skin microbiome in an individual,” Dr. Versalovic says. “As we continue to advance our knowledge of the human microbiome in chronic disease, pathologists will be able to recommend medications, and perhaps diet and lifestyle changes, based on microbiome analysis.”

Antennas are already raised. Many cosmetic and medical companies are keenly interested in topical and oral pre- and probiotics as a way to prevent and treat disease. “It’s a whole new world,” he says.