Assessing the effects of common topical exposures on skin bacteria associated with atopic dermatitis

Summary Background While patients and families struggling with atopic dermatitis (AD) have documented concerns for a contributory role of skin care products in AD pathology, nearly all the skin microbiome studies to date have asked participants to avoid topical products (such as soaps or select medications) for the preceding days to weeks prior to sample collection. Thus, given the established role of the microbiome in AD, the interactions between topical exposures, dysbiosis and AD remains underrepresented in the academic literature. Objectives To address this knowledge gap, we expanded our previous evaluations to test the toxicological effects of a broader range of common chemicals, AD treatment lotions, creams and ointments using both health‐ and AD‐associated strains of Roseomonas mucosa and Staphylococcus spp. Methods Use of in vitro culture techniques and mouse models were deployed to identify chemicals with dysbiotic or pre‐biotic potential. A proof‐of‐concept study was subsequently performed in healthy volunteers to assess global microbiome shifts after exposure to select chemicals using dermatologic patch testing. Results Numerous chemicals possessed antibiotic properties, including many not marketed as anti‐microbials. Through targeted combination of potentially beneficial chemicals, we identified combinations which promoted the growth of health‐associated isolates over disease‐associated strains in bacterial culture and enhanced microbe‐specific outcomes in an established mouse model of AD; the most promising of which was the combination of citral and colophonium (often sold as lemon myrtle oil and pine tar). Additional studies would likely further optimize the combination of ingredients use. Similar results were seen in the proof‐of‐concept human studies. Conclusions Our results could offer a systematic, multiplex approach to identify which products carry dysbiotic potential and thus may guide formulation of new topicals to benefit patients with AD.