PURPOSE OF THE STUDY:
To investigate the association between the skin microbiome and the development of atopic dermatitis (AD) through several assessments in the first year of life by skin examinations, skin microbiome sampling, transepidermal water loss quantification, and determination of other historical variables for analysis.
STUDY POPULATION:
Three hundred forty-six newborns were selected from the Preventing Atopic Dermatitis and Allergies in Children (PreventADALL) study, a population-based randomized controlled trial and observational study approved for data collection until 2044. Participants were born in Norway and represented the first participants from whom clinical data and skin samples were available longitudinally. The cohort was estimated to include at least 50 AD patients based on an anticipated prevalence of 23%.
METHODS:
Skin microbiome sampling was performed on the left lateral upper arm at 1 day after birth and at 3, 6, and 12 months of age. Transepidermal water loss (g/m2 per hour) was measured at the same location beginning at 3 months of age along with skin examination. Skin bacterial communities were assessed by 16S rRNA gene amplicon sequencing to include 970 samples. Background information was recorded on electronic questionnaires regarding parental history, environmental factors, breastfeeding, skin and/or food interventions, and type of birth delivery was determined from the hospital charts.
RESULTS:
There were strong temporal variations in the composition of the skin bacterial communities during the first year of life, with distinct patterns associated with different ages. Certain compositions were associated with skin barrier integrity, dry skin, later onset of AD, and to some extent, food allergies. Birth delivery mode had a strong impact on the microbiome composition at birth, with each mode leading to distinct patterns of colonization. Other factors, including parental history, environment, and breastfeeding, also had identifiable effects on the microbiome, albeit some transiently.
CONCLUSIONS:
There are a variety of factors that influence skin microbiome composition. Variations in the skin bacterial community in early life were associated with later manifestations of AD, dry skin, and reduced skin barrier integrity. Although some changes in the microbiome appear transient, these may have a role in the priming and development of the immune system.
REVIEWER COMMENTS:
Understanding the role of the human microbiome in the potential development of, as well as prevention of, disease is an active area of investigation in AD and allergic disease. This report provides data on an initial short longitudinal study from a birth cohort that shows the influence of microbiome composition on development of AD but also provides the potential for observations out to the year 2044 in this cohort. Studies like this may help guide us in the future in mitigation strategies for reducing AD and allergic disease morbidity.
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