Bioderma Congress Reports EWMA 2026

Reports written by Dr Elena CONDE MONTERO (Dermatologist, Spain)

Speakers: Sophie Charlotte Liegenfeld (Hamburg) and Chris Callewaert (Ghent)

Pathogenic and non-pathogenic microbes in the wound microbiome—how to flip the switch?

Speaker: Sophie Charlotte Liegenfeld (Hamburg)

Dr. Sophie Charlotte Liegenfeld focused her presentation on the role of the wound microbiome in chronic wound pathophysiology and on the concept that not all microorganisms present within a wound should be regarded as pathogenic. The speaker explained that healthy skin is characterized by high microbial diversity and a relatively stable ecological balance that contributes to protection against pathogen colonization. 

In contrast, chronic wounds are associated with reduced microbial diversity, predominance of a limited number of bacterial species, and biofilm formation, all of which contribute to delayed healing.

The speaker emphasized that microorganisms such as Staphylococcus aureus and Corynebacterium may be identified both in healthy skin and in chronic wounds. She stressed that the clinical significance of a microorganism depends not only on its presence, but also on the wound microenvironment and host conditions. In this context, commensal bacteria may shift toward pathogenic behaviour under unfavorable local conditions.

Dr. Liegenfeld reviewed the microorganisms most frequently associated with chronic wounds, including Staphylococcus aureus, Pseudomonas aeruginosa, Enterobacter spp., Proteus mirabilis, and Corynebacterium spp. She also highlighted the potential protective role of commensal organisms such as Staphylococcus epidermidis and Cutibacterium acnes in maintaining microbial balance.

A major concept presented during the lecture was the transition from a traditional “microbial eradication” approach toward the concept of “microbiome modulation.” The speaker argued that future wound management strategies should aim to restore and maintain microbial equilibrium rather than indiscriminately eliminate bacteria.

Several therapeutic strategies for microbiome modulation were discussed. These included debridement when clinically indicated, moisture and exudate control to stabilize the wound environment, and pH modulation. Dr. Liegenfeld explained that lowering wound pH may inhibit biofilm formation and pathogen predominance, although she acknowledged that no universally defined target pH currently exists for all wound types.

Finally, the speaker discussed the potential role of probiotics as a future therapeutic approach capable of positively modifying the wound microbiome and supporting wound healing, describing them as a potentially transformative strategy in the field.

Gut/skin axis & its importance in skin conditions

Speaker: Chris Callewaert (Ghent)

Dr. Chris Callewaert presented an overview of the gut–skin axis and the emerging evidence linking intestinal microbiota, diet, immune modulation, and skin diseases. The speaker began by highlighting the marked reduction in skin bacterial diversity associated with urbanization and modern Western lifestyles.

He explained that Western dietary patterns significantly influence gut immune function, affecting innate and adaptive immune responses as well as intestinal epithelial cells. According to the speaker, many immunological mechanisms involved in intestinal homeostasis are closely related to those regulating skin immunity, supporting the concept of a functional gut–skin axis.

Dr. Callewaert emphasized the modulatory effects of several metabolites and dietary compounds on both gut and skin physiology. Among the compounds discussed were vitamin D, GABA, catechins, polyphenols, lycopene, phytomolecules, serotonin, dopamine, and acetylcholine. Particular attention was given to short-chain fatty acids (SCFAs) derived from dietary fibre fermentation, which were described as key mediators linking gut and skin health. The speaker noted that reduced populations of SCFA-producing bacteria have been reported in inflammatory skin diseases such as psoriasis, atopic dermatitis, and hidradenitis suppurativa.

The presentation also addressed the relationship between systemic therapies and microbiome modulation. Dr. Callewaert explained that reducing inflammation through biologic therapies, such as adalimumab, may indirectly reduce Staphylococcus aureus abundance in inflammatory skin diseases.

Regarding hidradenitis suppurativa, the speaker reviewed microbiome alterations involving microorganisms such as Saccharomyces, Prevotella, and Porphyromonas, illustrating the complex microbial dysbiosis associated with the disease. He also discussed the relationship between diet, microbiota, and body odour, summarizing this concept with the statement: “we smell how we eat.”

The lecture additionally referred to diabetic foot ulcers as an example of the complex interaction between microbiota, inflammation, immunity, and tissue repair.

During the discussion session, it was acknowledged that current evidence regarding the gut–skin axis remains limited and that further studies are required to better understand these interactions. It was also emphasized that skin barrier integrity should not be overlooked when discussing the impact of diet and microbiota on skin diseases.

Reports written by Dr Elena CONDE MONTERO (Dermatologist, Spain)

Speakers: Sara Magalhães (Lisbon, Portugal), Rubelio B Martinez Morales (Mexico), Maria del Pilar Zárate Moreno (Mexico City, Mexico) and Alejandro Vivero (Córdoba, Argentina)

Lifestyle medicine foundations: why wound care requires a systemic approach

Speaker: Sara Magalhães (Lisbon, Portugal)

Dr. Sara Magalhães introduced the principles of Lifestyle Medicine and discussed why wound care should be approached from a systemic and holistic perspective rather than focusing exclusively on local wound management. The speaker began by presenting the six pillars of Lifestyle Medicine, including sleep, nutrition, physical activity, stress management, social connection, and healthy behaviours. She emphasized that chronic wounds are not isolated local problems, but conditions strongly influenced by behavioural, metabolic, psychological, and social determinants.

During the presentation, Dr. Magalhães insisted that Lifestyle Medicine is frequently misunderstood. One of the key messages was that it should not be considered alternative medicine, but rather an evidence-based discipline grounded in physiology and clinical research. 

She also stressed that Lifestyle Medicine is not simply “giving advice,” but involves structured and measurable interventions requiring proper clinical assessment and follow-up.

Another important point emphasized by the speaker was that Lifestyle Medicine should not become a form of patient blaming. She explained that human behaviour is influenced by biology and context, and therefore clinicians should focus on increasing patient capacity and support rather than generating guilt. In addition, she highlighted that Lifestyle Medicine is not unrealistic or excessively time-consuming idealism, since even small and targeted interventions may significantly influence clinical outcomes and can be integrated into routine practice.

The speaker also discussed practical communication skills required for behavioural interventions, presenting the OARS model (Open-ended questions, Affirmations, Reflective listening, and Summaries). 

She explained that these communication tools may help clinicians better explore patients’ perceptions, reinforce positive changes, improve therapeutic relationships, and facilitate adherence to lifestyle modifications.

Another concept presented was the transtheoretical model of behavioural change by Prochaska and DiClemente. Dr. Magalhães emphasized that effective interventions require understanding the stage at which the patient is situated within the behavioural change process, including pre-contemplation, contemplation, preparation, action, maintenance, and relapse.

Finally, the speaker addressed the challenges of implementing Lifestyle Medicine in clinical practice. 

These included limited consultation time and resources, lack of training and support systems, gaps between evidence and real-world implementation, limited awareness among healthcare professionals and policymakers, institutional resistance to change, socioeconomic and cultural barriers affecting patient adherence, and limited commercial incentives for non-pharmacological interventions. She concluded by emphasizing the need for truly interdisciplinary teams in wound care and encouraged participants to “prescribe” activities in the community to prevent loneliness.

Lifestyle determinants of tissue repair: mechanisms and clinical evidence

Speaker: Rubelio B Martinez Morales (Mexico)

Dr. Rubelio Martínez focused his presentation on the mechanisms through which lifestyle factors influence wound healing and discussed the current evidence supporting Lifestyle Medicine interventions in wound care.

One of the key points emphasized by the speaker was that perfect clinical trials rarely exist in real-world wound care. He explained that many traditional study designs fail to fully reflect the complexity and heterogeneity of patients encountered in daily clinical practice. Despite the limitations of the current evidence, Dr. Martínez Morales argued that the influence of lifestyle factors on tissue repair is biologically plausible and increasingly supported by emerging research.

The speaker described Lifestyle Medicine as a patient-centred approach in which patients play an active role in their own health and healing process. He stressed that patients not only have power over many behavioural determinants of health, but also responsibility in maintaining long-term therapeutic changes.

Several physiological mechanisms linking lifestyle and wound healing were discussed. These included the effects of sleep, nutrition, stress management, emotional wellbeing, social connection, and behaviour on inflammation, immune regulation, metabolic function, and tissue regeneration. Dr. Martínez Morales referred to EWMA documents addressing Lifestyle Medicine in wound care and highlighted the growing recognition of these concepts within international wound healing societies.

The lecture also stressed the importance of continuing to generate scientific evidence in this field. Although the current literature remains limited in some areas, the speaker noted that there is increasing global interest in Lifestyle Medicine, with a growing number of professional associations and scientific initiatives dedicated to this discipline.

The speaker also referred to the limitations of the current evidence regarding physical activity interventions in wound healing. He highlighted that “lack of evidence” should not be interpreted as “evidence of lack of effect,” particularly in complex patient populations. 

Factors such as age, frailty, reduced mobility, and obesity may influence patients’ ability to engage in physical activity and may partly explain the heterogeneity observed across studies. He emphasized the need for more individualized and realistic interventions adapted to real-world patients.

When lifestyle changes transform wound outcomes: real cases and practical lessons

Speaker: Maria del Pilar Zárate Moreno (Mexico City, Mexico)

Dr. Zárate presented several clinical cases illustrating the impact of lifestyle factors on wound healing outcomes and emphasized the importance of adopting a holistic and patient-centred perspective in clinical practice.

One of the most important concepts highlighted during the presentation was that wound improvement does not necessarily imply overall patient recovery. The speaker presented examples of patients whose wounds showed progressive local healing under appropriate wound care while the patients themselves experienced clinical deterioration, including fatigue, syncope, anaemia, and declining functional status due to severe undernutrition and inadequate systemic support.

Dr. Zárate emphasized that nutritional interventions must be realistic and adapted to the patient’s social and cultural context in order to be effective. She advocated for the use of familiar foods and dietary recommendations that fit local eating patterns and socioeconomic realities rather than idealized nutritional prescriptions that patients may be unable to follow.

Another major message of the lecture was that healing does not occur in isolation. The speaker stressed the importance of patient engagement, family involvement, and environmental factors in the healing process. 

Attention should not only focus on the wound itself, but also on the patient’s home environment, daily routines, social relationships, and emotional wellbeing.

The speaker also discussed how hospitalization, stress, loneliness, and disconnection from normal life may negatively influence recovery. According to Dr. Zárate, wound closure alone should not be considered the sole marker of successful treatment if the patient remains physically, emotionally, or socially compromised.

Overall, the presentation reinforced the importance of understanding wound healing within the broader context of the patient’s life and highlighted the value of practical, individualized, and socially adapted interventions.

How can we apply lifestyle medicine in wound care? exploring ideas together

Speaker: Alejandro Vivero (Córdoba, Argentina)

Dr. Alejandro Vivero focused his presentation on the practical application of Lifestyle Medicine principles in wound care, shared clinical cases, and emphasized the importance of adapting interventions to the reality of patients with chronic wounds.

One of the clinical cases presented involved a patient with a severe arterial ulcer who refused amputation. According to the speaker, substantial improvements in metabolic status and eventual wound healing were achieved through lifestyle modifications, particularly physical activity and nutritional optimization. The case was presented as an example of how Lifestyle Medicine may contribute not only to wound healing but also, in some cases, to limb preservation.

The speaker emphasized that pain plays a central role in the deterioration of patients with chronic wounds. Due to pain, many patients experience poor sleep quality and spend prolonged periods with their legs in dependent positions, which may worsen oedema and delay healing. Dr. Vivero therefore insisted that reducing pain and improving sleep quality should be considered therapeutic priorities during the first stages of wound management.

Another major topic addressed during the lecture was the relationship between obesity, chronic inflammation, reduced mobility, and wound chronicity. The speaker stressed that patients with chronic wounds should be encouraged to move whenever possible, although he acknowledged the major barriers faced by many patients, including frailty, amputations, dementia, disability, loneliness, depression, and social isolation.

Dr. Vivero highlighted the importance of empathy and personalized medicine in helping patients achieve realistic goals. He explained that family members may become important therapeutic partners in improving adherence and supporting behavioural change. The presentation also included practical examples of simple interventions, such as ankle dorsiflexion exercises, which may improve calf muscle pump function and, when combined with compression therapy, contribute to wound healing.

During the conclusions, the speaker emphasized that Lifestyle Medicine extends beyond metabolic diseases and can be successfully applied to patients with chronic wounds. He highlighted that many Lifestyle Medicine interventions are essentially free and may have a substantial impact on patient outcomes. According to Dr. Vivero, the priorities during the first week of management should include identifying the wound aetiology, reducing pain, and improving sleep quality. He also insisted on the importance of addressing the disease causing the wound together with wound management itself and considering the patient’s social context. Finally, the lecture concluded by reinforcing the need for multidisciplinary teams, which were associated with better clinical outcomes.

Reports written by Dr Elena CONDE MONTERO (Dermatologist, Spain)

Speakers: Terry Swanson (Australia) and Georgina Gethin (Galway, Ireland)

The role of pH in wound healing 

Speaker: Terry Swanson (Australia)

Dr. Terry Swanson discussed the important role of wound pH in tissue repair, chronic inflammation, biofilm persistence, bacterial proliferation, and antimicrobial efficacy. The speaker began by explaining that the pH of intact skin is normally acidic, ranging between 4.5 and 6.5, mainly due to the presence of free fatty acids, natural moisturizing factors, urocanic acid, carbonic acid, and keratins. In contrast, acute wounds have been reported to present a mean pH of approximately 7.4, while chronic wounds are frequently more alkaline, with reported pH values ranging from 7.15 to 8.9.

The speaker discussed the important role of wound pH in chronic wound healing, biofilm persistence, and antimicrobial efficacy. Alkaline wound environments were described as promoting bacterial adhesion, biofilm stability, and interspecies microbial communication, contributing to chronic inflammation, tissue breakdown, and delayed healing. Infection itself may further increase wound pH through the production of alkaline bacterial by-products such as ammonia, creating a vicious cycle that supports bacterial persistence, protease activity, and extracellular matrix degradation.

The lecture also emphasized that wound pH can significantly influence the efficacy of cleansing solutions and antiseptics. 

Most antiseptics were reported to be less effective in alkaline conditions, while povidone-iodine, silver, and hypochlorous acid may perform better in slightly acidic environments. The speaker reviewed additional factors affecting antiseptic efficacy, including biofilm presence, exudate amount, exposure time, and solution concentration, highlighting the importance of “antiseptic stewardship” in wound care.

Finally, the presentation explored the influence of pH on cellular activity and tissue repair. Wound pH was described as affecting oxygen release into tissues, angiogenesis, collagen formation, macrophage and fibroblast activity, microbial proliferation, and skin graft take. Particular attention was given to the Bohr effect, explaining that lower pH enhances oxygen release from hemoglobin into tissues. Slightly acidic environments were considered favorable for wound healing, especially due to improved fibroblast proliferation and extracellular matrix production.

Overall, the speaker emphasized that maintaining a slightly acidic wound environment may help control protease activity, reduce bacterial burden, preserve newly formed tissue, and promote faster and more effective healing. Dr. Swanson concluded by highlighting the future potential of pH-responsive dressings and wearable technologies capable of dynamically modulating wound pH to reduce biofilm formation, improve antimicrobial efficacy, and support tissue regeneration.

pH as a diagnostic tool

Speaker: Georgina Gethin (Galway, Ireland)

Dr. Georgina Gethin focused her lecture on the potential role of wound pH as a diagnostic and prognostic biomarker in wound care and questioned whether pH measurement currently fulfills the criteria required to be considered a clinically useful diagnostic tool.

The presentation reviewed the existing literature evaluating wound pH in acute wounds, chronic wounds, and infected wounds. The speaker explained that wound depth and tissue characteristics may influence pH values, making interpretation more complex in clinical practice. 

Several studies assessing pH measurement as a wound assessment tool were discussed, including Wound pH and Surface Temperature as a Predictive Biomarker of Healing and Evaluation of pH Measurement as a Method of Wound Assessment.

A major topic addressed during the lecture was the relationship between wound pH and healing trajectories. Non-healing wounds were described as typically associated with a more alkaline environment, whereas healing wounds tend to become progressively more acidic over time. A possible pH threshold between 7.6 and 7.8 was discussed as a potential indicator of poor healing. Observational studies showed that healing wounds frequently demonstrate a gradual reduction in pH over time, and that a decrease of one pH unit may correlate with significant wound size reduction.

Particular attention was given to the practical clinical relevance of pH measurement. One of the central questions repeatedly raised during the lecture was whether knowing the pH of a wound truly changes clinical decision-making in daily practice. Dr. Gethin questioned whether pH measurement currently provides actionable information beyond what clinicians already obtain through standard clinical assessment, especially in situations such as suspected infection or delayed healing. The speaker suggested that pH measurement may potentially become useful as an adjunctive tool in difficult-to-assess wounds, such as clinically infected wounds, although current evidence remains insufficient for routine implementation.

The lecture also introduced the concept of “theranostics,” in which wound pH could function both as a diagnostic biomarker and as a therapeutic target. Smart dressings incorporating pH sensors and colorimetric technologies were presented, including systems potentially compatible with smartphone-based visualization and monitoring. 

However, Dr. Gethin emphasized that no current pH-monitoring technology has yet achieved the level of standardization, affordability, and clinical validation necessary for routine medical use.

The presentation concluded that future developments should focus on clinically meaningful, easy-to-use, and cost-effective pH-monitoring systems capable of supporting real-world clinical decision-making and potentially transforming chronic wound care management.