Cutaneous microbiome effects of fluticasone propionate cream and adjunctive bleach baths in childhood atopic dermatitis - 17/08/16
Abstract |
Background |
Patients with atopic dermatitis (AD) are prone to skin infections, with microbes such as Staphylococcus aureus suspected of contributing to pathogenesis. Bleach baths might improve AD by reducing skin microbial burden.
Objective |
We sought to characterize the microbiota of lesional and nonlesional skin in young children with AD and control subjects and compare changes after treatment with a topical corticosteroid (TCS) alone or TCS + dilute bleach bath.
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 bleach bath. Microbial DNA was extracted for quantitative polymerase chain reaction of predominant genera and 16S rRNA sequencing.
Results |
At baseline, densities of total bacteria and Staphylococcus, including Staphylococcus aureus, were significantly higher at the worst AD lesional site than nonlesional (P = .001) or control (P < .001) skin; bacterial communities on lesional and nonlesional AD skin significantly differed from each other (P = .04) and from control (P < .001). After TCS + bleach bath or TCS alone, bacterial compositions on lesional skin normalized (P < .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 bleach bath treatment.
Conclusions |
Treatment with a TCS 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.
Le texte complet de cet article est disponible en PDF.Key words : atopic dermatitis, bleach baths, cutaneous microbiome, quantitative polymerase chain reaction, 16S sequencing, Staphylococcus aureus, topical corticosteroids
Abbreviations used : AD, EASI, NYU, NYULMC, PCR, qPCR, rRNA, TCS
Plan
| Dr Gonzalez was a recipient of a Pediatric Dermatology Fellowship Award from the Dermatology Foundation and Dr Schaffer received a Medical Dermatology Career Development Award from the Dermatology Foundation. Dr Gonzalez was supported in part by a gift from the Bohnert Foundation. This work used computing resources at the High Performance Computing Facility of the Center for Health Informatics and Bioinformatics at the New York University Langone Medical Center. Supported in part by UH2 AR057506 and New York University Clinical and Translational Science Awards grant UL1 TR000038 from the National Institutes of Health, and by the Diane Belfer Program in Human Microbial Ecology, and C&D Research Fund. |
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| Conflicts of interest: None declared. |
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| Supplementary items are available at www.jaad.org/. |
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| Reprints not available from the authors. |
Vol 75 - N° 3
P. 481 - septembre 2016 Retour au numéro
Article précédent
- CME examination
- Efficacy and safety of crisaborole ointment, a novel, nonsteroidal phosphodiesterase 4 (PDE4) inhibitor for the topical treatment of atopic dermatitis (AD) in children and adults
- Amy S. Paller, Wynnis L. Tom, Mark G. Lebwohl, Robin L. Blumenthal, Mark Boguniewicz, Robert S. Call, Lawrence F. Eichenfield, Douglass W. Forsha, William C. Rees, Eric L. Simpson, Mary C. Spellman, Linda F. Stein Gold, Andrea L. Zaenglein, Matilda H. Hughes, Lee T. Zane, Adelaide A. Hebert
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