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Skin pH–dependent Staphylococcus aureus abundance as predictor for increasing atopic dermatitis severity
Author(s) -
Hülpüsch Claudia,
Tremmel Karolina,
Hammel Gertrud,
Bhattacharyya Madhumita,
Tomassi Amedeo,
Nussbaumer Thomas,
Neumann Avidan U.,
Reiger Matthias,
TraidlHoffmann Claudia
Publication year - 2020
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/all.14461
Subject(s) - atopic dermatitis , staphylococcus aureus , scorad , microbiome , transepidermal water loss , dysbiosis , medicine , staphylococcal skin infections , dermatology , skin infection , immunology , psoriasis , biology , disease , pathology , bacteria , bioinformatics , genetics , stratum corneum , dermatology life quality index
Background Atopic eczema (atopic dermatitis, AD) is characterized by disrupted skin barrier associated with elevated skin pH and skin microbiome dysbiosis, due to high Staphylococcus aureus loads, especially during flares. Since S aureus shows optimal growth at neutral pH, we investigated the longitudinal interplay between these factors and AD severity in a pilot study. Method Emollient (with either basic pH 8.5 or pH 5.5) was applied double‐blinded twice daily to 6 AD patients and 6 healthy (HE) controls for 8 weeks. Weekly, skin swabs for microbiome analysis (deep sequencing) were taken, AD severity was assessed, and skin physiology (pH, hydration, transepidermal water loss) was measured. Results Physiological, microbiome, and clinical results were not robustly related to the pH of applied emollient. In contrast to longitudinally stable microbiome in HE, S aureus frequency significantly increased in AD over 8 weeks. High S aureus abundance was associated with skin pH 5.7‐6.2. High baseline S aureus frequency predicted both increase in S aureus and in AD severity (EASI and local SCORAD) after 8 weeks. Conclusion Skin pH is tightly regulated by intrinsic factors and limits the abundance of S aureus . High baseline S aureus abundance in turn predicts an increase in AD severity over the study period. This underlines the importance and potential of sustained intervention regarding the skin pH and urges for larger studies linking skin pH and skin S aureus abundance to understand driving factors of disease progression.