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Assessing Skin Health and Treatment Effects for Pediatric AD
A microbial index of skin health (MiSH) has the potential to diagnose atopic dermatitis (AD), assess risk-prone state of skin, and predict treatment response in children across human populations, a new study found. A 3-city comparison of skin microbiota from AD and healthy pediatric cohorts revealed that although city has the greatest effect size, MiSH based on 25 bacterial genera can diagnose AD with 83% to ~95% accuracy within each city and 86.4% accuracy across cities. Other findings included:
- Nonlesional skin sites across the bodies of AD-active children harbor a distinct but lesional state-like microbiome that features relative enrichment of Staphylococcus aureus over health individuals.
- Pretreatment MiSH classified children with identical AD clinical symptoms into 2 host types with distinct microbial diversity and treatment effects of corticosteroid therapy.
Sun Z, et al. A microbiome-based index for assessing skin health and treatment effects for atopic dermatitis in children. [Published online ahead of print August 20, 2019]. mSystems. doi: 10.1128/mSystems.00293-19.
The skin microbiome is a very hot topic especially as it varies in individuals with AD. Several interesting points come from this impressive study. It reinforces the past understanding that non-lesional skin in a person with AD has bacterial content more similar to lesional skin than to the skin of a non-atopic. Amazingly, the skin microbiome could predict almost perfectly which of 3 cities in the study the person lived in. Their "microbial index of skin health" could distinguish between 2 microbiome types in patients who appeared almost identical clinically but who showed a different response to corticosteroids. Although we still do not understand if there is a cause and effect relationship, this study furthers our knowledge of the importance of the skin microbiome in AD. — Joseph Fowler, Jr., MD, Clinical Professor of Dermatology, University of Louisville, KY