Skin microbiome dysbiosis in leprosy cases

Vannia C. Teng, Prima K. Esti


The human skin possesses a microenvironment conducive to the growth of the skin microbiome, which plays in many physiological functions in cutaneous immunity homeostasis and maturation. The microbiome composition depends on many variables, such as endogenous (host condition) or exogenous (environmental) factors and topographic location. Host-skin microbes’ interaction can be mutualism or pathogenicity. Dysbiosis or alteration in skin microbiota is associated with various dermatological diseases, including leprosy. Dysbiosis is driven by the alteration of the microbial communities themselves or due to the intrinsic features of the host. Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae targeting the nerves and skin, leading to loss of sensation on the skin, with or without dermatologic lesions, and correlated with long term consequences, such as deformities or disability. Microvascular dysfunction and significant alterations in capillary structure due to invasion of M. leprae lead to altered hydration levels of the skin caused by disruption of blood flow; which changes the resident microbial community structure. The skin microbiome composition differences in leprosy patient’s skin lesions were observed; skin microbial diversity in the leprosy patients was lower than in healthy individuals. The diversity reduction was observed in freshly diagnosis leprosy patients, those at various stages of MDT, and post-MDT; indicated that both the interaction between skin microbial community and M. leprae or the ongoing therapeutic regimen impacted the skin microbiome variation. 



Leprosy, Skin microbiome, Dysbiosis, Microbial variation

Full Text:



Weyrich LS, Dixit S, Farrer AG, Cooper AJ, Cooper AJ. The skin microbiome: Associations between altered microbial communities and disease. Australas J Dermatol. 2015;56(4):268-74.

Kang S, Amagai M, Bruckner AL, Enk AH, Margolis DJ, McMichael AH et al. Fitzpatrick’s Dermatology. 9th ed. McGrawHill. 2019;2.

World Health Organization. Regional Office for South-East Asia. Guidelines for the diagnosis, treatment and prevention of leprosy. World Health Organization. Regional Office for South-East Asia. 2018. Available at iris/bitstream/handle/10665/274127/9789290226383-eng.pdf. Accessed 24 August 2021.

Bhat RM, Prakash C. Leprosy: An Overview of Pathophysiology. Interdiscip Perspect Infect Dis. 2012;2012:181089.

Bhandari J, Awais M, Robbins BA, Gupta V. Leprosy. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. Available at: Accessed on 2021 Jul 5.

Panduan Praktis Klinis bagi Dokter Spesialis Kulit dan Kelamin di Indonesia. Perhimpunan Dokter Spesialis Kulit dan Kelamin Indonesia (PERDOSKI). 2017.

Meisel JS, Sfyroera G, Bartow-McKenney C, Gimblet C, Bugayev J, Horwinski J et al. Commensal microbiota modulate gene expression in the skin. Microbiome. 2018;6(1):20.

Lambers H, Piessens S, Bloem A, Pronk H, Finkel P. Natural skin surface pH is on average below 5, which is beneficial for its resident flora. Int J Cosmet Sci. 2006;28(5):359-70.

Balato A, Cacciapuoti S, Di Caprio R, Marasca C, Masarà A, Raimondo A et al. Human Microbiome: Composition and Role in Inflammatory Skin Diseases. Arch Immunol Ther Exp (Warsz). 2019;67(1):1-18.

Foulongne V, Sauvage V, Hebert C, Dereure O, Cheval J, Gouilh MA et al. Human Skin Microbiota: High Diversity of DNA Viruses Identified on the Human Skin by High Throughput Sequencing. PLOS ONE. 2019;7(6):e38499.

Dominguez-Bello MG, Costello EK, Contreras M, Magris M, Hidalgo G, Fierer N et al. Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns. Proc Natl Acad Sci U S A. 2010;107(26):11971-5.

Scharschmidt TC, Vasquez KS, Truong H-A, Gearty SV, Pauli ML, Nosbaum A et al. A wave of regulatory T cells into neonatal skin mediates tolerance to commensal microbes. Immunity. 2015;43(5):1011-21.

Luna PC. Skin Microbiome as Years Go By. Am J Clin Dermatol. 2020;21(1):12-7.

Grice EA, Segre JA. The skin microbiome. Nat Rev Microbiol. 2011;9(4):244-53.

Byrd AL, Belkaid Y, Segre JA. The human skin microbiome. Nat Rev Microbiol. 2018;16(3):143-55.

Ying S, Zeng D-N, Chi L, Tan Y, Galzote C, Cardona C et al. The Influence of Age and Gender on Skin-Associated Microbial Communities in Urban and Rural Human Populations. PLoS One. 2015;10(10):e0141842.

Callewaert C, Ravard Helffer K, Lebaron P. Skin Microbiome and its Interplay with the Environment. Am J Clin Dermatol. 2020;21(1):4-11.

Chen YE, Fischbach MA, Belkaid Y. Skin microbiota–host interactions. Nature. 2018;553(7689):427-36.

Bayal N, Nagpal S, Haque MM, Patole MS, Valluri V, Suryavanshi R et al. 16S rDNA-based skin microbiome data of healthy individuals and leprosy patients from India. Sci Data. 2019;6(1):225.

Chng KR, Tay ASL, Li C, Ng AHQ, Wang J, Suri BK et al. Whole metagenome profiling reveals skin microbiome-dependent susceptibility to atopic dermatitis flare. Nat Microbiol. 2016;1(9):1-10.

Quan C, Chen X-Y, Li X, Xue F, Chen L-H, Liu N et al. Psoriatic lesions are characterized by higher bacterial load and imbalance between Cutibacterium and Corynebacterium. J Am Academy Dermatol. 2020;82(4):955–61.

Szegedi A, Dajnoki Z, Bíró T, Kemény L, Törőcsik D. Acne: Transient Arrest in the Homeostatic Host-Microbiota Dialog? Trends in Immunol. 2019;40(10):873-6.

Sanford JA, Gallo RL. Functions of the skin microbiota in health and disease. Semin Immunol. 2013;25(5):370-7.

Bayal N, Nagpal S, Haque MM, Patole MS, Shouche Y, Mande SC et al. Structural aspects of lesional and non-lesional skin microbiota reveal key community changes in leprosy patients from India. Sci Rep. 2021;11:3294.

Gunawan H, Suwarsa O, Alkatirie D, Sutedja E, Dwiyana RF, Hindritiani R. The First Report of Diversity Analyses of Skin Microbiome In Indonesian Leprosy Patient. Research Square. 2020. Available at: article/rs-82654/v1. Accessed on 2021 Jul 8.

Silva PES, Reis MP, Ávila MP, Dias MF, Costa PS, Suhadolnik MLS et al. Insights into the skin microbiome dynamics of leprosy patients during multi-drug therapy and in healthy individuals from Brazil. Sci Rep. 2018;8(1):8783.

Gao Z, Tseng C, Strober BE, Pei Z, Blaser MJ. Substantial alterations of the cutaneous bacterial biota in psoriatic lesions. PLoS One. 2008;3(7):e2719.

Silva PE, Costa PS, Ávila MP, Suhadolnik MLS, Reis MP, Salgado APC et al. Leprous lesion presents enrichment of opportunistic pathogenic bacteria. Springerplus. 2015;4:187.

Silva PES, Reis MP, Ávila MP, Dias MF, Costa PS, Suhadolnik MLS, et al. Insights into the skin microbiome dynamics of leprosy patients during multi-drug therapy and in healthy individuals from Brazil. Sci Rep. 2018;8:8783.

Cundliffe E, Demain AL. Avoidance of suicide in antibiotic-producing microbes. J Ind Microbiol Biotechnol. 2010;37(7):643-72.