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Diet and Microbiome Influence on Alopecia Areata: Experience from Case Reports

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Alopecia areata (AA) is a potentially reversible auto-immune non-scarring baldness on the scalp, which can be extended to the entire body. There are many scientific evidence as regards the impact of diet on scalp diseases related to hair growth. Diet is also able to strongly influence gut microbiome. On the contrary, few evidence reports as regards the link between microbiome, especially scalp microbiome and hair diseases. Here we reported a two case-reports study on patients affected by AA, with and without lactose intolerance, respectively, with the aim to underline how diet could emphasize microbiome changing related to scalp disease. Subjects were asked to fill out a 7-day dietary survey and scalp and oral swabs were collected. Data from the dietary survey, qRT-PCR on main bacterial strains inhabiting the scalp and 16S sequencing of the scalp and oral microbiome were matched and compared each other and with healthy and general AA population. Beyond diet well-known impact on general human health, our results highlighted the role of diet in modifying oral and scalp microbiome, which in turn seems to have an impact on AA evolution. The findings of the present works suggested a kind of intercorrelation between microbial dysbiosis on the scalp of patients with AA and dietary habits.
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Rinaldi et al. J Nutri Med Diet Care 2019, 5:037
Volume 5 | Issue 1
DOI: 10.23937/2572-3278.1510037
ISSN: 2572-3278
Open Access
Journal of
Nutritional Medicine and Diet Care
Citaon: Rinaldi F, Pinto D, Giuliani G, Sorbellini E (2019) Diet and Microbiome Inuence on Alopecia
Areata: Experience from Case Reports. J Nutri Med Diet Care 5:037.
Accepted: July 20, 2019: Published: July 22, 2019
Copyright: © 2019 Rinaldi F, et al. This is an open-access arcle distributed under the terms of the
Creave Commons Aribuon License, which permits unrestricted use, distribuon, and reproducon
in any medium, provided the original author and source are credited.
Page 1 of 8 Rinaldi et al. J Nutri Med Diet Care 2019, 5:037
Diet and Microbiome Inuence on Alopecia Areata: Experience
from Case Reports
Fabio Rinaldi, MD1,2,3*, Daniela Pinto1,2,3, Giammaria Giuliani1,22,3
1Giuliani S.p.A., Italy
2Human Advanced Microbiome Project-HMAP, Italy
3Internaonal Hair Research Foundaon (IHRF), Italy
*Corresponding author: Rinaldi Fabio, MD, Internaonal Hair Research Foundaon (IHRF), Milan, Italy, Tel: +39-2-
Alopecia areata (AA) is a potentially reversible auto-immune
non-scarring baldness on the scalp, which can be extended
to the entire body. There are many scientic evidence as
regards the impact of diet on scalp diseases related to hair
growth. Diet is also able to strongly inuence gut microbi-
ome. On the contrary, few evidence reports as regards the
link between microbiome, especially scalp microbiome and
hair diseases. Here we reported a two case-reports study
on patients affected by AA, with and without lactose intoler-
ance, respectively, with the aim to underline how diet could
emphasize microbiome changing related to scalp disease.
Subjects were asked to ll out a 7-day dietary survey and
scalp and oral swabs were collected. Data from the dietary
survey, qRT-PCR on main bacterial strains inhabiting the
scalp and 16S sequencing of the scalp and oral microbiome
were matched and compared each other and with healthy
and general AA population. Beyond diet well-known impact
on general human health, our results highlighted the role of
diet in modifying oral and scalp microbiome, which in turn
seems to have an impact on AA evolution. The ndings of
the present works suggested a kind of intercorrelation be-
tween microbial dysbiosis on the scalp of patients with AA
and dietary habits.
Alopecia areata, Hair disorders, Dietary therapy, Microbi-
ome, Dysbiosis
Check for
nutrient’s intake. Even though the role of macro and
micronutrients in normal hair follicle development has
not been completely claried [2], the impact of diet and
nutrional deciencies on hair growth diseases is well
documented [3,4].
Diet is also reported to have ability of shaping the gut
microbiome [5,6] but also skin microbiome in relaons
to some dermatological condions [7,8] especially acne
and psoriasis. Poor knowledge is currently available as
regards dermatological condions aecng the scalp
and hair growth.
Among hair growth disorders, Alopecia areata (AA)
is reported as the second most common disorder
aecng the scalp [9]. AA is a type of non-scarring
baldness aecng the scalp and, eventually the enre
body [10] which causes have been strictly associated
with immunity and inammaon [9,11,12].
In the past two years researchers focused their at-
tenon also on the role of microbial community inhab-
ing the scalp and hair growth disorders, including AA
[13-17]. More recently Nair and collaborator reported
evidence as regards the role for the gut microbiome
in the pathogenesis of AA [18]. Taking together these
ndings pose the need of a more deeply invesgaon
as regards the link between diet, microbiome and hair
growth disorders.
In the present work, we reported a two case-reports
study on paents aected by Alopecia areata, with and
Hair follicle is a dynamic mini-organ [1] with an high
cellular turnover. As a consequence, hair follicle is char-
acterized by a very acve metabolism requiring a good
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Page 2 of 8 Rinaldi et al. J Nutri Med Diet Care 2019, 5:037
me of inclusion. The clinical evaluaon reported 100%
hair loss of the scalp based on the Severity of Alopecia
Tool (SALT) Score [19] with no signs of erythema or
scaling. Eyebrows, eyelashes, and body hair were also
completely absent. The paent demographics include
being Caucasian, weight 72 kg, height 1.80 m, and BMI
22.2 kg/m2.
Case report 2
A 36-year-old female (Figure 3) came to the clinic
reporng a history of strong hair loss since one month.
Other reported symptoms are severe itching, psoriasis
on the scalp, birch and pauliary allergy, insomnia and
high sensaon of fague. The paent is also intolerant
without lactose intolerance, respecvely, with the aim
to underline how diet could emphasize microbiome
changing related to scalp disease (Figure 1).
Case Presentaon
Case report 1
A 17-year-old male (Milan, Italy), aected by Alopecia
universalis (Figure 2). The paent presented to the
dermatology clinic with a history of rapidly progressing
total body hair loss. There was no history of similar
illness in family members and also no history of drug
intake and trauma. Previously treatment includes stem
cell therapy. No therapy for at least 3 months at the
Figure 1: Diet importance in microbiome changing related to scalp disease.
Figure 2: Alopecia universalis affected male.
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Page 3 of 8 Rinaldi et al. J Nutri Med Diet Care 2019, 5:037
to lactose. Clinical evaluaon showed strong hair loss
but no signal of miniaturizaon. Alopecia areata was
conrmed by histological examinaon. No therapy for
at least 3 months at the me of inclusion. The paent
demographics include being Caucasian, weight 48 kg,
height 1.62 m, and BMI 18.3 kg/m2.
Nutrient intake
Both subjects were asked to ll out a 7-day dietary
survey at the me of enrollment, following being
instructed by a diecian on how to record the food and
beverages consumed. The Winfood soware (Winfood
2.7 Medimaca Srl, Colonnella, Italy) was used for
analysis of surveys by esmang the energy intake and
the percentage of macronutrients and micronutrients.
Data collected were compared to the tables of food
consumpon and recommended dietary intakes of
the Italian Naonal Instute of Nutrion and Food
Composion Database in Italy.
Samples collecon
Before sampling paents had to avoid the use of
anbiocs in the last 30 days no probiocs, the use
of probiocs in the last 15 days, to perform the last
shampoo 48 h before sampling. They also did not have
to undergo to an-tumor, immunosuppressant or
radiaon therapy in the last 3 months and also topical
or hormonal therapy on the scalp. The study was under
the approval of the Ethical Independent Commiee for
Clinical, not pharmacological invesgaon in Genoa
(Italy) and in accordance with the ethical standards of
the 1964 Declaraon of Helsinki. All of the volunteers
signed the informed consent.
Microbiome samples were collected from the scalp
(minimum area sampled of 16 cm2) and oral mucosa with
a sterile coon swab, previously soaked in ST soluon
(NaCl 0.15 M and 0.1% Tween 20) for at least 30s
[20,21]. Samples from the same subjects were collected
together and stored at 4°C unl DNA extracon. Sterile
coon swabs placed in ST soluon have been used as
negave controls.
DNA extracon and 16s amplicon generaon and
sequencing: Genomic DNA from scalp swabs was ex-
tracted by mean of QIAamp UCP Pathogen Mini Kit
(Qiagen) according to manufacturer protocol, with mi-
nor modicaons [22]. Aer extracon, bacterial DNA
was suspended in DNAse free water and quaned by
the QIAexpert system (Qiagen) before sequencing and
For sequencing, variable region V3-V4 was ampli-
ed by mean of the following universal primers: 341 F
TACNVGGGTWTCTAAT [25-27]. Library preparaon and
Illumina MiSeq V3-V4 sequencing were carried out at
StarSEQ GmbH, Mainz, Germany, according to Capora-
so, et al. [28] and Kozich, et al. [29] methods, with mi-
nor modicaons. Real-Time Analysis soware (RTA) v.
1.16.18 and 1.17.22, MiSeq Control Soware (MCS) v.
2.0.5 and 2.1.13 were using.
qRT-PCR of main bacterial species: Main bacterial
species (Propionibacterium acnes, Staphylococcus epi-
dermidis and Staphylococcus aureus) on the scalp were
quaned by real-me quantave PCR (RT qPCR),
using Microbial PCR assay kit (Qiagen). Samples were
mixed with 12.5 μL of Microbial qPCR Mastermix, 1 μL
of Microbial DNA qPCR Assay, 5 ng of genomic DNA
sample and Microbial-DNA-free water up to a nal
volume of 25 μL. Posive PCR Control, No Template
Control, and Microbial DNA Posive Control were also
included. Pan-bacteria assays are also included as pos-
ive controls for the presence of bacterial DNA, as hu-
man GAPDH and HBB1 for the determinaon of proper
sample collecon. Following thermal cycling condions
were used: 95 °C for 10 min, 40 cycles of 95 °С for 15
sec, 60 °C for 2 min. Each PCR reacon was performed in
duplicate using an MX3000p PCR machine (Stratagene,
La Jolla, CA). Relave abundance in the expression of
each strain was calculated using the ΔΔCt method [30],
normalizing fold-change against Pan Bacteria, using
MX3000p soware (v.3; Stratagene).
Stascal analysis
Data are expressed as Relave abundance % ± SEM
for qRT-PCR analysis. Results were checked for normal
distribuon using the D'Agosno & Pearson normality
test before further analyses. Stascally signicant
dierences in the bacterial community were determined
by Student's t with Welch's correcon. Analyses
were performed with GraphPad Prism 7.0 (GraphPad
Soware, Inc., San Diego, CA). P-values equal to or less
than 0.05 were considered signicant.
Results and Discussion
In the present work, we invesgated diet impact
on microbial dysbiosis caused by the presence of AA
which in turn could impact on disorder evoluon and
The preliminary analysis of macronutrients % in-
take (data not shown) suggested a Mediterranean diet
framework [31] for both case reports included in the
present study. Case report 1 diet included processed
food, red meat and low intake of fruits and vegetables.
Case report 2 diet included vegetables, fruit, peas, and
beans (legumes) and grains. When analyzed more deep-
ly as regards the type of proteins, lipids and carbohy-
drates ingested, diet from case-report 1 is beer classi-
ed as High fat-diet (more processed food, sugars, and
few bers). The second case reports can be considered,
instead, as following the Mediterranean like diet (lower
fruits intake compared to normal Mediterranean regi-
Tables 1 and Table 2 show the intake of macronutri-
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Page 4 of 8 Rinaldi et al. J Nutri Med Diet Care 2019, 5:037
The daily amount of total calories was signicantly
dierent among case reports (p < 0.01) (1,331.58 ±
ents and micronutrients in both case reports, compared
to Recommended (LARN) values in Italy.
Table 1: Daily reported energy and nutrient intake of studied case reports, assessed by a 7-day weighed food record. LARN:
Nutrition and Energy Reference Assuming Levels. a-cValues with different superscript letters, in the same row, differ signicantly
(P < 0.05).
Daily Intake Recommended
Case report 1 Case report 2
Total calories
M: 2000-2400a
F: 1800-2300
1,331.58 ± 189.61b693.09 ± 143.48c
Total proteins
75a60.93 ± 15.19a37.11 ± 16.01b
Animal proteins
(% of total proteins)
40a72.44 ± 10.14b47.33 ± 2.01a
Vegetal proteins
(% of total proteins)
60a27.56 ± 11.22b52.67 ± 4.05a
Total lipids
65a50.58 ± 18.81a29.11 ± 4.64b
Total carbohydrates
290a165.80 ± 22.15b75.54 ± 18.88c
220a95.15 ± 35.35b27.72 ± 28.77b
23a16.59 ± 13.23a7.44 ± 1.33b
255a126.50 ± 81.79a51.76 ± 39.61b
Saturated fatty acids
(% of total)
7a10.06 ± 6.31a3.12 ± 1.00b
Polyunsaturated fatty acids
(% of total)
18a6.45 ± 1.31b6.36 ± 1.82b
Monounsaturated fatty acids
(% of total)
4a11.74 ± 5.01b15.06 ± 5.24b
Table 2: Daily reported micronutrient intake of studied case reports, assessed by a 7-day weighed food record. LARN: Nutrition
and Energy Reference Assuming Levels. a-cValues with different superscript letters, in the same row, differ signicantly (P < 0.05).
Daily Intake Recommended
Case report 1 Case report 2
Calcium (mg) M: 1200a
F: 1500
419.06 ± 406.77b141.05 ± 47.31c
Iron (mg) 18a5.50 ± 1.66b4.26 ± 1.91b
Zinc (mg) 7a7.33 ± 2.59a4.03 ± 1.30a
Folic acid (µg) 200a149.25 ± 43.89a67.33 ± 24.08b
Niacin (mg) 14a7.79 ± 3.45b9.05 ± 4.22b
Riboavin (mg) 1.2a0.45 ± 0.11b0.46 ± 0.25b
Thiamine (mg) 0.9a0.65 ± 0.16a0.48 ± 0.30a
Vitamin A (µg) 600a1,147.00 ± 141.88b499.68 ± 351.71c
Vitamin B6 (mg) 1.1a0.99 ± 0.38a0.70 ± 0.29a
Vitamin C (mg) 70a42.33 ± 25.41a19.57 ± 29.15a
Vitamin D (µg) 10a0.78 ± 1.48b4.58 ± 6.55a
Vitamin E (mg) 8a3.21 ± 2.57b10.25 ± 3.81b
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Page 5 of 8 Rinaldi et al. J Nutri Med Diet Care 2019, 5:037
report 1 and case report 2, respecvely. Case report 1
also has a signicant (p < 0.01) lower intake of niacin
(7.79 ± 3.45) and vitamin E (3.21 ± 2.57) and higher (p <
0.001) intake of vitamin A.
Unbalancing in nutrients intakes is reported to have
an inuence both on hair follicle structure and hair
growth diseases such as telogen euvium, androgenet-
ic alopecia, AA and cicatricial alopecia [4,32-35].
Indeed, many of the above cited micronutrients are
reported to aect the hair follicle as regards restoraon
of hair growth, cell division, cycling [3]. Therefore, Singh
and collaborators [5] also highlighted diet eect on gut
microbiome. The same eect has been reported on oral
microbiome [36].
189.61 and 3.09 ± 143.48, respecvely) (Table 1).
Food diary from both subjects also reported a very
small intake of ber (16.59 ± 13.23 and 7.44 ± 1.33,
respecvely) and polyunsaturated fay acids (6.45 ±
1.31 and 6.36 ± 1.82, respecvely). Therefore, a lower
percentage of saturated fay acid intake was reported
for case report 2 (3.12 ± 1.00).
As regards micronutrients intake (Table 2) we
noced signicant lower intake of iron (5.50 ± 1.66 and
4.26 ± 1.91 vs. recommended) (p < 0.001) and folic acid
(149.25 ± 43.89 and 67.33 ± 24.08 vs. recommended)
(p < 0.01), riboavin (0.45 ± 0.11 and 0.46 ± 0.25 vs.
recommended) (p < 0.01) and vitamin D (0.78 ± 1.48
and 4.58 ± 6.55 vs. recommended) (p < 0.01) for case
Figure 4: Distribution of main bacterial strains in healthy subjects and AA subjects.
Figure 3: Women with initial stages of Alopecia areata.
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Page 6 of 8 Rinaldi et al. J Nutri Med Diet Care 2019, 5:037
sults found in another autoimmune disease [42]. In both
case reports, an increase of Proteobacteria (33.28% and
27.71%, respecvely) has been reported. Most interest-
ing, analysis of sequences from case report 1 bacterial
oral DNA showed a decrease in Bidobacteria. A link
between a high-fat diet and this phylum decrease was
previously reported [43] thus conrming the role of diet
in inuencing oral bacterial composion. A signicant
reducon of Bacteroidetes has been found in case re-
port 2 compared to healthy control subjects. Since the
high intake of n-6 PUFA by case report 2, a link between
diet and this microbial unbalance could be hypothesized
as also suggested by some authors [44].
Results on bacterial composion of scalp microbi-
ome conrm our previous ndings on microbial shi
on the scalp in paents aected by AA [14,15]. In the
present work, we invesgated if dierent dietary habits
can re-modulate this microbial dysbiosis with the aim
to highlight the strict intercorrelaon between diet and
oral but especially scalp microbiome of these subjects.
The case reports of the present work represent just an
example of a larger clinical invesgaon we are leading
on this topic. For example, our clinical observaons sug-
gest that, in some paents aected by non-celiac gluten
sensivity (NCGS), AA manifestaons systemacally re-
curred following a non-gluten free diet. An explicave
photographic example was reported in Figure 6. Most
interesng this modulaon reects also in the microbi-
al composion of scalp microbiome (data not shown)
enhancing the existence of a link between diet and skin
bacterial communies scalp microbiome.
Data from the present study add to knowledge to
this evidence also highlighng that not only gut but
Evidence on the inuence of diet and microbiome
dysbiosis on skin disorders are mainly linked to topic
dermas [37], acne vulgaris [8,38-40], and psoriasis
[41]. In our previous works [14,15] on scalp microbial
community in hair growth disorders we showed, for the
very rst me, the presence of scalp bacterial shi in
such kind of disorders.
Figure 4 reports the % of the distribuon of main
bacterial strains in case report 1 and case report 2
compared with data from 15 healthy subjects and 15 AA
subjects in our database.
Data from case report 1 showed an increase in
P. acnes populaon and parallel decrease both of S.
epidermidis and S. aureus species. These data are in
line with data from the panel of AA subjects and clearly
evidence the presence of bacterial dysbiosis compared
to healthy control.
On the contrary, the percentage of distribuon of
main bacterial species in case report 2 resulted more
similar to the healthy populaon (Figure 4). Even if an
interindividual dierence has to be considered, the
analysis of food diary of the panel of een AA subjects
and case report 1 and 2 strongly suggested the impact
of diet in shaping scalp microbiome.
Data from oral bacterial DNA sequencing corrobo-
rated these ndings (Figure 5). Also, in this case, data
from case report 1 and 2 were compared to data from
our internal database of healthy and AA subjects, previ-
ously collected. The analysis of sequence at the phylum
level highlighted a slow decrease of Firmicutes both for
case report 1 and 1 (Figure 6) and these results are in
line with our previous ndings in AA subjects and re-
Figure 5: Data from oral bacterial DNA sequencing corroborated these ndings.
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Page 7 of 8 Rinaldi et al. J Nutri Med Diet Care 2019, 5:037
6. Scott KP, Gratz SW, Sheridan PO, Flint HJ, Duncan
SH (2013) The inuence of diet on the gut microbiota.
Pharmacol Res 69: 52-60.
7. Vaughn AR, Notay M, Clark AK, Sivamani RK (2017) Skin-
gut axis: The relationship between intestinal bacteria and
skin health. World J Dermatol 6: 52-58.
8. Bowe WP, Joshi SS, Shalita AR (2010) Diet and acne. J
Am Acad Dermatol 63: 124-141.
9. Dawber R (1989) Alopecia areata. Monogr Dermatol 2: 89-
10. Odom RB, Davidsohn IJ, William D, Henry JB, Berger
TG (2006) Clinical diagnosis by laboratory methods. In:
Elston Dirk M, Andrews’ Diseases of the Skin: Clinical
Dermatology. Saunders Elsevier.
11. Brenner W, Diem E, Gschnait F (1979) Coincidence
of vitiligo, alopecia areata, onychodystrophy, localized
scleroderma and lichen planus. Dermatologica 159: 356-
12. Trink A, Sorbellini E, Bezzola P, Rodella L, Rezzani R,
et al. (2013) A randomized, double-blind, placebo- and
active-controlled, half-head study to evaluate the effects of
platelet-rich plasma on alopecia areata. Br J Dermatol 169:
13. Clavaud C, Jourdain R, Bar-Hen A, Magali Tichit,
Christiane Bouchier, et al. (2013) Dandruff is associated
with disequilibrium in the proportion of the major bacterial
and fungal populations colonizing the scalp. PLoS One 8:
14. Rinaldi F, Pinto D, Marzani B, Rucco M, Giuliani G, et al.
(2018) Human microbiome: What's new in scalp diseases.
J Transl Sci 4: 1-4.
15. Pinto D, Sorbellini E, Marzani B, Rucco M, Giuliani G, et al.
(2019) Scalp bacterial shift in Alopecia areata. PLoS One
14: e0215206.
16. Ho BS, Ho EXP, Chu CW, Ramasamy S, Bigliardi-Qi M,
et al. (2019) Microbiome in the hair follicle of androgenetic
alopecia patients. PLoS One 14: e0216330.
17. Polak-Witka K, Rudnicka L, Blume-Peytavi U, Vogt A (2019)
The role of the microbiome in scalp hair follicle biology and
disease. Exp Dermatol.
18. L Nair, Z Dai, AM Christiano (2017) 649 Gut microbiota
also oral and scalp microbiome could be modulated by
dietary habits.
Nowadays, the study of human microbiome rep-
resents a novel diagnosc and therapeuc approach to
treat many human condions, also including that strict-
ly related to skin and scalp. Beyond diet well-known im-
pact on general human health, our results highlighted
the role of diet in modifying oral and scalp microbiome,
which in turn seems to have an impact on Alopecia
areata evoluon.
According to our ndings and previous reported
evidence cited above, the modulaon of the gut
microbiome by mean of diet could represents a valid
approach in the managing of hair growth disorders,
especially AA, in which also the permeability of the gut
can be compromised [44].
This study was supported by Giuliani SpA.
Conict of Interest
R.F. and S.E. serve as a consultant for Giuliani S.p.A.
P.D. is employed by Giuliani S.p.A.
1. Schneider MR, Schmidt-Ullrich R, Paus R (2009) The hair
follicle as a dynamic miniorgan. Curr Biol 19: R132-R142.
2. Almohanna HM, Ahmed AA, Tsatalis JP, Tosti A (2019)
The Role of Vitamins and Minerals in Hair Loss: A Review.
Dermatol Ther (Heidelb) 9: 51-70.
3. Guo EL, Katta R (2017) Diet and hair loss: Effects of nutrient
deciency and supplement use. Dermatol Pract Concept 7:
4. Finner AM (2013) Nutrition and hair: Deciencies and
supplements. Dermatol Clin 31: 167-172.
5. Singh RK, Chang HW, Yan D, Lee KM, Ucmak D, et
al. (2017) Inuence of diet on the gut microbiome and
implications for human health. J Transl Med 15: 73.
Figure 6: A slow decrease of Firmicutes.
ISSN: 2572-3278DOI: 10.23937/2572-3278.1510037
Page 8 of 8 Rinaldi et al. J Nutri Med Diet Care 2019, 5:037
smooth muscle cell motility during aging. J Biol Chem 283:
31. Castro-Quezada I, Román-Viñas B, Serra-Majem L (2014)
The mediterranean diet and nutritional adequacy: A review.
Nutrients 6: 231-248.
32. Rushton DH (2002) Nutritional factors and hair loss. Clin
Exp Dermatol 27: 396-404.
33. Mubki T, Rudnicka L, Olszewska M, Shapiro J (2014)
Evaluation and diagnosis of the hair loss patient: Part I.
History and clinical examination. J Am Acad Dermatol 71:
34. Spivak JL, Jackson DL (1997) Pellagra: An analysis of 18
patients and a review of the literature. Johns Hopkins Med
J 140: 295-309.
35. Goldberg LJ, Lenzy Y (2010) Nutrition and hair. Clin
Dermatol 28: 412-419.
36. Kato I, Vasquez A, Moyerbrailean G, Land S, Djuric Z, et al.
(2017) Nutritional correlates of human oral microbiome. J
Am Coll Nutr 36: 88-98.
37. Manam S, Tsakok T, Till S, Flohr C (2014) The association
between atopic dermatitis and food allergy in adults. Curr
Opin Allergy Clin Immunol 14: 423-429.
38. Cordain L, Lindeberg S, Hurtado M, Hill K, Eaton SB, et
al. (2002) Acne vulgaris: A disease of Western civilization.
Arch Dermatol. 138: 1584-1590.
39. Grossi E, Cazzaniga S, Crotti S, Naldi L, Di Landro A, et
al. (2016) The constellation of dietary factors in adolescent
acne: A semantic connectivity map approach. J Eur Acad
Dermatol Venereol 30: 96-100.
40. Zouboulis CC, Jourdan E, Picardo M (2014) Acne is an
inammatory disease and alterations of sebum composition
initiate acne lesions. J Eur Acad Dermatol Venereol 28:
41. Zákostelská Z, Málková J, Klimešová K, Pavel Rossmann,
Michaela Hornová, et al. (2016) Intestinal microbiota
promotes psoriasis-like skin inammation by enhancing
Th17 response. PLoS One 11: e0159539.
42. Zhang C, Zhang M, Wang S, Han R, Cao Y, et al. (2010)
Interactions between gut microbiota, host genetics and diet
relevant to development of metabolic syndromes in mice.
ISME J 4: 232-241.
43. Turnbaugh PJ, Bäckhed F, Fulton L, Gordon JI (2008)
Diet-induced obesity is linked to marked but reversible
alterations in the mouse distal gut microbiome. Cell Host
Microbe 3: 213-223.
44. Mu Q, Kirby J, Reilly CM, Luo XM, (2017) Leaky gut as a
danger signal for autoimmune diseases. Front Immunol 8:
plays a role in the development of alopecia areata. Journal
of Investigative Dermatology 137: S112.
19. Olsen EA, Hordinsky MK, Price VH, Roberts JL, Shapiro
J, et al. (2004) Alopecia areata investigational assessment
guidelines--Part II. National Alopecia Areata Foundation. J
Am Acad Dermatol 51: 440-447.
20. Grice EA, Kong HH, Conlan S, Deming CB, Davis J, et al.
(2010) Topographical and temporal diversity of the human
skin microbiome. Science 324: 1190-1192.
21. Paulino LC, Tseng CH, Strober BE, Blaser MJ (2006)
Molecular analysis of fungal microbiota in samples from
healthy human skin and psoriatic lesions. J Clin Microbiol
44: 2933-2941.
22. Gao Z, Perez-Perez GI, Chen Y, Blaser MJ (2010)
Quantitation of major human cutaneous bacterial and
fungal populations. J Clin Microbiol 48: 3575-3581.
23. Klindworth A, Pruesse E, Schweer T, Jörg Peplies, Christian
Quast, et al. (2013) Evaluation of general 16S ribosomal
RNA gene PCR primers for classical and next-generation
sequencing-based diversity studies. Nucleic Acids Res 41:
24. Takahashi S, Tomita J, Nishioka K, Hisada T, Nishijima M
(2014) Development of a prokaryotic universal primer for
simultaneous analysis of bacteria and archaea using next-
generation sequencing. PLoS One 9: e105592.
25. Apprill A, McNally S, Parsons R, Weber L (2015) Minor
revision to V4 region SSU rRNA 806R gene primer greatly
increases detection of SAR11 bacterioplankton. Aquat
Microb Ecol 75: 129-137.
26. Parada AE, Needham DM, Fuhrman JA (2016) Every base
matters: assessing small subunit rRNA primers for marine
microbiomes with mock communities, time series and
global eld samples. Environ Microbiol 18: 1403-1414.
27. Walters W, Hyde ER, Berg-Lyons D, Ackermann G,
Humphrey G, et al. (2015) Improved bacterial 16S rRNA
Gene (V4 and V4-5) and fungal internal transcribed spacer
marker gene primers for microbial community surveys.
mSystems 1.
28. Caporaso JG, Lauber CL, Walters WA, Berg-Lyons D,
Lozupone CA, et al. (2011) Global patterns of 16S rRNA
diversity at a depth of millions of sequences per sample.
Proc Natl Acad Sci USA 108: 4516-4522.
29. Kozich JJ, Westcott SL, Baxter NT, Highlander SK, Schloss
PD (2013) Development of a dual-index sequencing strategy
and curation pipeline for analyzing amplicon sequence data
on the MiSeq Illumina sequencing platform. Appl Environ
Microbiol 79: 5112-5120.
30. Vigetti D, Viola M, Karousou E, Rizzi M , Moretto P, et al.
(2008) Hyaluronan-CD44-ERK1/2 regulate human aortic
... Badacze wskazują również na istotę mikrobiomu jelit modulowanego poprzez nawyki żywieniowe i jego wpływ na terapię zaburzeń wzrostu włosów, w tym łysienia plackowatego [21]. ...
... Przy rozpoznaniu z jakimi patogenami związana jest choroba należy pobrać wymaz. W celu zdiagnozowania trądziku, najwłaściwiej jest pobrać wymaz z wydzieliny ropnej [21]. Badania mikrobiologiczne, takie jak posiew bakteriologiczny czy mykologiczny, służą do identyfikacji i weryfikacji występujących patogenów u pacjentów [8]. ...
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Probiotics are live microorganisms that have a positive effect on the host organism. They are used in the food, pharmacological and cosmetology industries. The basic function of probiotics is prevention and prophylaxis against the induction and development of disease entities. An important factor is the influence of probiotic bacteria on the etiopathogenesis of acne formation, reducing the amount of pro-inflammatory cytokines, as well as other skin diseases, such as psoriasis, allergies, and atopic dermatitis by reducing inflammation. The aim of the article to summarize the current scientific knowledge available regarding the use of probiotic bacteria in the cosmetology industry. Probiotics do not show carcinogenic effects, and even show a protective effect before their development and are safe to use. In cosmetology they show anti-aging, moisturizing, rejuvenating and protective properties against ultraviolet radiation.
... The role of diet in AA can also be hypothesised [101,102]. Firstly, an unbalanced diet can lead to a lower intake of some macronutrients and micronutrients, and this can have an impact on gut microbial composition and functionality as well as the microbiome inhabiting the scalp up to the perifollicular region [101]. Hair is a fast-growing element, which needs a balanced supply of nutrients to grow correctly [9,102]. ...
... Firstly, an unbalanced diet can lead to a lower intake of some macronutrients and micronutrients, and this can have an impact on gut microbial composition and functionality as well as the microbiome inhabiting the scalp up to the perifollicular region [101]. Hair is a fast-growing element, which needs a balanced supply of nutrients to grow correctly [9,102]. ...
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The continuous research advances in the microbiome field is changing clinicians’ points of view about the involvement of the microbiome in human health and disease, including autoimmune diseases such as alopecia areata (AA). Both gut and cutaneous dysbiosis have been considered to play roles in alopecia areata. A new approach is currently possible owing also to the use of omic techniques for studying the role of the microbiome in the disease by the deep understanding of microorganisms involved in the dysbiosis as well as of the pathways involved. These findings suggest the possibility to adopt a topical approach using either cosmetics or medical devices, to modulate or control, for example, the growth of overexpressed species using specific bacteriocins or postbiotics or with pH control. This will favour at the same time the growth of beneficial bacteria which, in turn, can impact positively both the structure of the scalp ecosystem on the host’s response to internal and external offenders. This approach, together with a “systemic” one, via oral supplementation, diet, or faecal transplantation, makes a reliable translation of microbiome research in clinical practice and should be taken into consideration every time alopecia areata is considered by a clinician.
... Trichohyalin from hair follicle epithelial cells could also be deamidated by transglutaminases. This signals the similarity between AA and other autoimmune diseases, such as celiac disease, which is usually a comorbidity of AA [56][57][58]. Oxidation is another antigen modification, especially under the oxidative stress environment of AA [59]. T cell responsiveness to the autoantigens after modification is a known initiating and persistent factor in autoimmune disease progression. ...
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Alopecia areata (AA) is characterized by common non-scarring alopecia due to autoimmune disorders. To date, the specific pathogenesis underlying AA remains unknown. Thus, AA treatment in the dermatological clinic is still a challenge. Numerous clinical observations and experimental studies have established that melanocytes may be the trigger point that causes hair follicles to be attacked by the immune system. A possible mechanism is that the impaired melanocytes, under oxidative stress, cannot be repaired in time and causes apoptosis. Melanocyte-associated autoantigens are released and presented, inducing CD8+ T cell attacks. Thereafter, amplification of the immune responses further spreads to the entire hair follicle (HF). The immune privilege of HF subsequently collapses, leading to AA. Herein, we present a narrative review on the roles of melanocytes in AA pathogenesis, aiming to provide a better understanding of this disease from the melanocyte’s perspective.
... TCHH is also subjected to transglutaminase-mediated deamidation, which suggests similarities with other deamidation-mediated autoimmune disorders (e.g., celiac disease). Moreover, several reports have suggested comorbidity of celiac disease in AA patients (119)(120)(121), and some have speculated that an underlying intestinal inflammation may prime patients predisposed to AA (46). ...
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Alopecia areata (AA) is a chronic, multifactorial, polygenic, and heterogeneous disorder affecting growing hair follicles in susceptible individuals, which results in a non-scarring and reversible hair loss with a highly unpredictable course. Despite very considerable research effort, the nature of the precipitating factor(s) responsible for initiating AA in any given hair follicle remains unclear, due largely to significant gaps in our knowledge of the precise sequence of the etiopathogenic events in this dermatosis. However, disease-related changes in the immune-competence of the lower growing hair follicle, together with an active immune response (humoral and cellular) to hair follicle-associated antigens, are key associated phenomena. Confirmation of the hair follicle antigen(s) implicated in AA disease onset has remained stubbornly elusive. While it may be considered somewhat philosophical by some, it is also unclear whether immune-mediated hair loss in AA results from a) an ectopic (i.e., in an abnormal location) immune response to native (unmodified) self-antigens expressed by the healthy hair follicle, b) a normal immune response against modified self-antigens (or neoantigens), or c) a normal immune response against self-antigens (modified/non-modified) that were not previously visible to the immune system (because they were conformationally-hidden or sequestered) but become exposed and presentable in an MHC-I/-II molecule-restricted manner. While some candidate hair follicle antigen target(s) in AA are beginning to emerge, with a potential role for trichohyalin, it is not yet clear whether this represents the initial and immunodominant antigenic focus in AA or is simply one of an expanding repertoire of exposed hair follicle tissue damage-associated antigens that are secondary to the disease. Confirmation of autoantigen identity is essential for our understanding of AA etiopathogenesis, and consequently for developing a more informed therapeutic strategy. Major strides have been made in autoantigen discovery in other autoimmune conditions. In particular, some of these conditions may provide insights into how post-translational modifications (e.g., citrullination, deamidation, etc.) of hair follicle-restricted proteins may increase their antigenicity and so help drive the anti-hair follicle immune attack in AA.
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Alopecia areata (AA) ist eine chronische, multifaktorielle, polygene und heterogene Erkrankung, die wachsende Haarfollikel bei anfälligen Personen betrifft und zu einem nicht vernarbenden und reversiblen Haarausfall mit höchst unvorhersehbarem Verlauf führt. Trotz sehr erheblichem Forschungsaufwand bleibt die Art des/der auslösenden Faktors/en, der/die für die Initiierung von AA in einem bestimmten Haarfollikel verantwortlich ist (sind), unklar, was weitgehend auf signifikante Wissenslücken bezüglich der genauen Abfolge der ätiopathogenen Ereignisse bei dieser Dermatose zurückzuführen ist. Jedoch sind krankheitsbedingte Veränderungen in der Immunkompetenz im unteren Bereich des wachsenden Haarfollikels zusammen mit einer aktiven Immunantwort (humoral und zellulär) auf Haarfollikel-assoziierte Antigene wichtige Schlüsselphänomene. Die genaue Identität des/der Haarfollikel-Antigens/e, das/die mit dem Ausbruch der AA-Krankheit in Verbindung steht/stehen, blieb schwer zu fassen. Während es von einigen als eher philosophische Frage angesehen werden mag, ist auch unklar, ob immunvermittelter Haarausfall bei AA die Folge von a) einer ektopischen (d.h. an einer abnormalen Stelle) Immunantwort auf native (unmodifizierte), vom gesunden Haarfollikel exprimierte Selbst-Antigene ist oder von b) einer normalen Immunantwort gegen modifizierte Selbst-Antigene (oder Neoantigene) oder von c) einer normalen Immunantwort gegen Selbst-Antigene (modifiziert/nicht modifiziert), die zuvor für das Immunsystem nicht sichtbar waren (weil sie konformationell versteckt oder sequestriert waren), aber auf eine MHC-I/II-Molekül-abhängige Weise exponiert und präsentierbar werden. Während sich einige potenzielle Haarfollikel-Zielantigene bei AA abzuzeichnen beginnen, mit einer potenziellen Rolle von Trichohyalin, ist noch unklar, ob dies den anfänglichen und immundominanten antigenen Fokus bei AA darstellt oder ob es nur eines aus einem wachsenden Repertoire von Antigenen ist, die mit den exponierten Gewebeschäden im Haarfollikel assoziiert sind und sekundär zur Krankheit beitragen. Die Bestätigung der Autoantigenidentität ist für unser Verständnis der AA-Ätiopathogenese und folglich für die Entwicklung einer fundierteren therapeutischen Strategie von großer Bedeutung. Große Fortschritte sind bei der Entdeckung von Autoantigenen im Zusammenhang mit anderen Autoimmunerkrankungen erzielt worden. Insbesondere können einige dieser Erkrankungen darüber Aufschluss geben, wie posttranslationale Modifikationen (z.B. Citrullinierung, Desamidierung usw.) von Haarfollikel-spezifischen Proteinen ihre Antigenität erhöhen und so dazu beitragen können, den Anti-Haarfollikel-Immunangriff bei AA voranzutreiben.
Background Alopecia areata (AA) is a non-scarring hair loss disorder of autoimmune etiology. Objective To familiarize physicians with the clinical presentation, diagnosis, evaluation, and management of pediatric alopecia areata. Methods The search term "Alopecia areata" was entered into a Pubmed search. A narrow scope was applied to the categories of "epidemiology", "clinical diagnosis", "investigations", "comorbidities", and "treatment". Meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews were included. Only papers published in the English language were included. A descriptive, narrative synthesis was provided of the retrieved articles. Results AA is an autoimmune disease of unknown etiology. It is the third most common dermatologic presentation in children with a lifetime risk of 1-2%. Diagnosing AA can be made on the basis of the history and clinical findings. Patients will often present with patchy, non-scarring hair loss generally affecting the scalp. History may reveal a personal or family medical history of autoimmune or atopic disease or a recent stressful event. Tricoscopic examination will classically show “exclamation point hairs” and “yellow dots”. Nonspecific nail changes may be present. Other clinical variants include alopecia totalis, alopecia universalis, ophiasis, sisaipho, and Canitis subita. There are multiple treatment options for AA including conservative treatment, and topical, oral, and injectable medications. Conclusion AA is an autoimmune disease with a heterogenous presentation and unpredictable clinical course. Although there is no cure for AA, there are many current treatment options available to help manage this disfiguring disease.
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Androgenetic alopecia is the most common form of hair loss in males. It is a multifactorial condition involving genetic predisposition and hormonal changes. The role of microflora during hair loss remains to be understood. We therefore analyzed the microbiome of hair follicles from hair loss patients and the healthy. Hair follicles were extracted from occipital and vertex region of hair loss patients and healthy volunteers and further dissected into middle and lower compartments. The microbiome was then characterized by 16S rRNA sequencing. Distinct microbial population were found in the middle and lower compartment of hair follicles. Middle hair compartment was predominated by Burkholderia spp. and less diverse; while higher bacterial diversity was observed in the lower hair portion. Occipital and vertex hair follicles did not show significant differences. In hair loss patients, miniaturized vertex hair houses elevated Propionibacterium acnes in the middle and lower compartments while non-miniaturized hair of other regions were comparable to the healthy. Increased abundance of P. acnes in miniaturized hair follicles could be associated to elevated immune response gene expression in the hair follicle.
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People commonly inquire about vitamin and mineral supplementation and diet as a means to prevent or manage dermatological diseases and, in particular, hair loss. Answering these queries is frequently challenging, given the enormous and conflicting evidence that exists on this subject. There are several reasons to suspect a role for micronutrients in non-scarring alopecia. Micronutrients are major elements in the normal hair follicle cycle, playing a role in cellular turnover, a frequent occurrence in the matrix cells in the follicle bulb that are rapidly dividing. Management of alopecia is an essential aspect of clinical dermatology given the prevalence of hair loss and its significant impact on patients’ quality of life. The role of nutrition and diet in treating hair loss represents a dynamic and growing area of inquiry. In this review we summarize the role of vitamins and minerals, such as vitamin A, vitamin B, vitamin C, vitamin D, vitamin E, iron, selenium, and zinc, in non-scarring alopecia. A broad literature search of PubMed and Google Scholar was performed in July 2018 to compile published articles that study the relationship between vitamins and minerals, and hair loss. Micronutrients such as vitamins and minerals play an important, but not entirely clear role in normal hair follicle development and immune cell function. Deficiency of such micronutrients may represent a modifiable risk factor associated with the development, prevention, and treatment of alopecia. Given the role of vitamins and minerals in the hair cycle and immune defense mechanism, large double-blind placebo-controlled trials are required to determine the effect of specific micronutrient supplementation on hair growth in those with both micronutrient deficiency and non-scarring alopecia to establish any association between hair loss and such micronutrient deficiency. Plain Language Summary: Plain language summary available for this article.
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Nowadays, the study of human microbiome represents a novel diagnostic and therapeutic approach to treat many human conditions, also including that strictly related to skin and scalp. The findings we included in the present work represent just an overview of a larger pioneer study on the involvement of changing of the microbiome in scalp diseases, especially that related to hair growth. Even just preliminary, our results strongly highlighted, for the first time, the role exerted by unbalancing on the normal resident microbial community in hair growth-related conditions.
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The intestinal epithelial lining, together with factors secreted from it, forms a barrier that separates the host from the environment. In pathologic conditions, the permeability of the epithelial lining may be compromised allowing the passage of toxins, antigens, and bacteria in the lumen to enter the blood stream creating a " leaky gut. " In individuals with a genetic predisposition, a leaky gut may allow environmental factors to enter the body and trigger the initiation and development of autoimmune disease. Growing evidence shows that the gut microbiota is important in supporting the epithelial barrier and therefore plays a key role in the regulation of environmental factors that enter the body. Several recent reports have shown that probiotics can reverse the leaky gut by enhancing the production of tight junction proteins; however, additional and longer term studies are still required. Conversely, pathogenic bacteria that can facilitate a leaky gut and induce autoimmune symptoms can be ameliorated with the use of antibiotic treatment. Therefore, it is hypothesized that modulating the gut microbiota can serve as a potential method for regulating intestinal permeability and may help to alter the course of autoimmune diseases in susceptible individuals.
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Patients presenting with hair loss should be screened by medical history, dietary history and physical exam for risk factors for nutrient deficiency. If warranted, laboratory studies may be performed. In patients with no risk factors, further laboratory evaluation searching for nutritional deficiencies is not warranted. For patients with nutritional deficiencies, it is clear that those deficiencies should be corrected. Further research is required to determine whether any benefit exists for nutrient supplementation in the absence of documented deficiency. At this time, patients must be informed that such research is lacking and that in fact some supplements carry the risk of worsening hair loss or the risk of toxicity.
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Recent studies have suggested that the intestinal microbiome plays an important role in modulating risk of several chronic diseases, including inflammatory bowel disease, obesity, type 2 diabetes, cardiovascular disease, and cancer. At the same time, it is now understood that diet plays a significant role in shaping the microbiome, with experiments showing that dietary alterations can induce large, temporary microbial shifts within 24 h. Given this association, there may be significant therapeutic utility in altering microbial composition through diet. This review systematically evaluates current data regarding the effects of several common dietary components on intestinal microbiota. We show that consumption of particular types of food produces predictable shifts in existing host bacterial genera. Furthermore, the identity of these bacteria affects host immune and metabolic parameters, with broad implications for human health. Familiarity with these associations will be of tremendous use to the practitioner as well as the patient.
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Background: Despite many potential effects of the oral microbiome on oral and systemic health, scant information is available regarding the associations between diet and the oral microbiome. Methods: Oral rinse DNA samples from 182 participants in a population-based case-control study for colorectal cancer were used to amplify a V3-V4 region of bacterial 16S rRNA gene. The amplicons were sequenced using Illumina MiSeq paired end chemistry on 2 runs, yielding approximately 33 million filtered reads that were assigned to bacterial classes. Relative abundances of each class and family as well microbial diversity/richness indices were correlated with selected dietary intakes from a food frequency questionnaire. Results: Saturated fatty acids (SFAs) and vitamin C intakes were consistently correlated with alpha (within-subjects) diversity indexes in both richness and diversity. SFA intake was positively correlated with relative abundance of betaproteobacteria and fusobacteria. Vitamin C and other vitamins with correlated intakes-for example, the B vitamins and vitamin E-exhibited positive correlations with fusobacteria class, its family Leptotrichiaceae and a clostridia family Lachnospiraceae. In addition, glycemic load was positively correlated with Lactobacillaceae abundance. Conclusion: The observed associations in this study were modest. However, the results suggest that the effects of diets are likely to be habitat specific, and observations from the gut microbiome are not transferrable to the oral microbiome. Further studies are warranted, incorporating a range of host biomarkers, such as cytohistological, molecular, or biochemical measurements, in order to address biological consequences of these dietary intakes in human oral health.
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Psoriasis is a chronic inflammatory skin disease in which Th17 cells play a crucial role. Since indigenous gut microbiota influences the development and reactivity of immune cells, we analyzed the link among microbiota, T cells and the formation of psoriatic lesions in the imiquimod-induced murine model of psoriasis. To explore the role of microbiota, we induced skin inflammation in germ-free (GF), broad-spectrum antibiotic (ATB)-treated or conventional (CV) BALB/c and C57BL/6 mice. We found that both mice reared in GF conditions for several generations and CV mice treated with ATB were more resistant to imiquimod-induced skin inflammation than CV mice. The ATB treatment dramatically changed the diversity of gut bacteria, which remained stable after subsequent imiquimod application; ATB treatment resulted in a substantial increase in the order Lactobacillales and a significant decrease in Coriobacteriales and Clostridiales. Moreover, as compared to CV mice, imiquimod induced a lower degree of local and systemic Th17 activation in both GF and ATB-treated mice. These findings suggest that gut microbiota control imiquimod-induced skin inflammation by altering the T cell response. © 2016 Zákostelská et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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We continue to uncover a wealth of information connecting microbes in important ways to human and environmental ecology. As our scientific knowledge and technical abilities improve, the tools used for microbiome surveys can be modified to improve the accuracy of our techniques, ensuring that we can continue to identify groundbreaking connections between microbes and the ecosystems they populate, from ice caps to the human body. It is important to confirm that modifications to these tools do not cause new, detrimental biases that would inhibit the field rather than continue to move it forward. We therefore demonstrated that two recently modified primer pairs that target taxonomically discriminatory regions of bacterial and fungal genomic DNA do not introduce new biases when used on a variety of sample types, from soil to human skin. This confirms the utility of these primers for maintaining currently recommended microbiome research techniques as the state of the art.