Cutaneous microbiome effects of fluticasone propionate cream and adjunctive bleach baths in childhood atopic dermatitis

Abstract

Background Patients with atopic dermatitis (AD) are prone to skin infections, with microbes like Staphylococcus aureus suspected of contributing to pathogenesis. Bleach baths might improve AD by reducing skin microbial burden. Objective To characterize the microbiota of lesional and nonlesional skin in young children with AD and controls and compare changes after treatment with a topical corticosteroid (TCS) alone or TCS + dilute bleach baths (BB). Methods In a randomized, placebo-controlled, single-blinded clinical trial in 21 children with AD and 14 healthy children, lesional and nonlesional AD skin was examined at baseline and after 4-week treatment with TCS alone or TCS plus BB. Microbial DNA was extracted for qPCR of predominant genera and 16S rRNA sequencing. Results At baseline, densities of total bacteria and Staphylococcus, including S. aureus, were significantly higher at the worst AD lesional site than nonlesional (p=0.001) or control (p<0.001) skin; bacterial communities on lesional and nonlesional AD skin significantly differed from each other (p=0.04) and from control (p<0.001). After TCS + BB or TCS alone, bacterial compositions on lesional skin normalized (p<0.0001), resembling nonlesional skin, with microbial diversity restored to control skin levels. Limitations The 4-week time period and/or the twice-weekly baths may not have been sufficient for additional impact on the cutaneous microbiome. More detailed sequencing may allow better characterization of the distinguishing taxa with BB-treatment. Conclusions Treatment with a topical corticosteroid cream suffices to normalize the cutaneous microbiota on lesional AD; after treatment, bacterial communities on lesional skin resemble nonlesional skin but remain distinct from control.

A systematic literature review of the human skin microbiome as biomarker for dermatological drug development

“…In particular, AD flare ups were associated with an increased proportion of Staphyloccocus sequences, and S. aureus abundance correlated with disease severity 60. In line with these results, microbial diversity in AD lesions was inversely correlated with overall eczema severity as observed by the EASI 63, with several further studies also reporting taxonomic normalization and increased bacterial diversity in AD lesional skin, following various treatments 60, 61, 63, 66.…”

“…The skin microbiome in patients with AD was assessed in 11 studies, Table 1 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66. A greater proportion of longitudinal studies and 2 completed randomized controlled trials were performed in AD patients.…”

“…A greater proportion of longitudinal studies and 2 completed randomized controlled trials were performed in AD patients. There is general consensus across studies that skin affected by AD exhibits decreased bacterial diversity, as a result of an increased abundance of S. aureus 60, 61, 62, 63, 64, 66. In particular, AD flare ups were associated with an increased proportion of Staphyloccocus sequences, and S. aureus abundance correlated with disease severity 60.…”

“…Currently, no evidence of benefit of antimicrobial interventions directed at reduction of Staphylococcus in patients with AD exists, only in secondarily impetiginized AD 69, 70, 71. As multiple studies included in this review indicate that the skin microbiota within an individual patient varies over time 60, 61, 63, 64, there is need for longitudinal, frequent sampling and standard analysis studies. Nevertheless, it has proven its potential value and is recommended to apply in AD clinical trials, in particular when microbiota can serve also as drug‐specific biomarker, i.e.…”

Микробиота Кожи И Возможности Ее Коррекции Пре- И Пробиотиками При Лечении Хронических Дерматозов

“…Многие данные указывают на связь между нарушением функции эпидермального барьера и изменением микробиома кожи [7,111,112]. Антибиотики и антисептики могут уменьшить кожную колонизацию S. aureus, но не норма-лизуют микробиом.…”