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Background  Emollients are a mainstay of treatment in atopic dermatitis (AD), a disease distinguished by skin bacterial dysbiosis. However, changes in skin microbiota when emollients are used as a potential AD preventative measure in infants remain incompletely characterized.    Results  We compared skin barrier parameters, AD development, and bacterial 16S ribosomal RNA gene sequences of cheek, dorsal and volar forearm samples from 6-month-old infants with a family history of atopy randomized to receive emollients (n = 11) or no emollients (controls, n = 12). The emollient group had a lower skin pH than the control group. The number of bacterial taxa in the emollient group was higher than in the control group at all sites. The  Streptococcus salivarius  proportion was higher in the emollient versus control groups at all sites.  S .  salivarius  proportion appeared higher in infants without AD compared to infants with AD. A decrease in  S .  salivarius  abundance was further identified in a separate larger population of older children demonstrating an inverse correlation between AD severity at sampling sites and  S .  salivarius  proportions.    Conclusions  The decreased skin pH and the increased proportion of  S .  salivarius  after long-term emollient use in infants at risk for developing AD may contribute to the preventative effects of emollients in high-risk infants.

Emollient use alters skin barrier and microbes in infants at risk for developing atopic dermatitis