title: 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 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.
authors.forename: Mercedes E
authors.initials: ME
authors.lastname: Gonzalez
authors.affiliation: Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.
authors.forename: Julie V
authors.initials: JV
authors.lastname: Schaffer
authors.affiliation: Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.
authors.forename: Seth J
authors.initials: SJ
authors.lastname: Orlow
authors.affiliation: Department of Medicine, New York University Langone Medical Center, New York, New York.
authors.forename: Zhan
authors.initials: Z
authors.lastname: Gao
authors.affiliation: Department of Population Health, Division of Biostatistics, New York University School of Medicine, New York, New York.
authors.forename: Huilin
authors.initials: H
authors.lastname: Li
authors.affiliation: Center for Health Informatics and Bioinformatics, Department of Medicine, Division of Translational Medicine, New York University School of Medicine, New York, New York.
authors.forename: Alexander V
authors.initials: AV
authors.lastname: Alekseyenko
authors.affiliation: Department of Medicine, New York University Langone Medical Center, New York, New York. Electronic address: Martin.Blaser@nyumc.org.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Blaser
mesh_terms: D000279:Administration, Cutaneous; D001494:Baths; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000188:drug therapy* / Q000382:microbiology*; D003879:Dermatologic Agents / Q000627:therapeutic use*; D005260:Female; D000068298:Fluticasone / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D064307:Microbiota / Q000187:drug effects*; D016037:Single-Blind Method; D012867:Skin / Q000382:microbiology*; D012973:Sodium Hypochlorite / Q000627:therapeutic use*; D013211:Staphylococcus aureus / Q000187:drug effects
chemical_list: D003879:Dermatologic Agents; D000068298:Fluticasone; D012973:Sodium Hypochlorite
keywords: 16S sequencing; Staphylococcus aureus; atopic dermatitis; bleach baths; cutaneous microbiome; quantitative polymerase chain reaction; topical corticosteroids