Skin Microbial Ecology in Atopic Dermatitis

Although the two most common inflammatory skin diseases (AD and Psoriasis) are now quite effectively managed with topical and/or systemic therapies, how this disease improvement is reflected in changes of skin microbial pathogens and commensals is still not well understood. We have several aims.

Aim 1 - Determine how the abundance of S. aureus, other microbes of interest including, but not exclusive to, coagulase-negative Staphylococcus species [CONS], and C. acnes on the skin surface varies as a function of time and/or disease activity in AD, plaque stage psoriasis (PS) and healthy, non-atopics (NA). Aim 2 - Validate whether a biomarker (or panel) identifies subjects with greater S. aureus burden (e.g., abundance). Aim 3 - Identify a biomarker (or panel) that predicts clinical improvement observed in our AD or PS subjects. Aim 4 - Quantify S. aureus virulence factors from skin swabs of all three subject populations. Exploratory Aim 5 - Develop a skin microbial repository (optional) where we will focus on the interplay between S. aureus and other microbes from AD and PS patients, and age- and gender-matched healthy NAs. Exploratory Aim 6 - Develop a repository of skin tape strips for biomarker and protease assays. Exploratory Aim 7 - (optional enrollment) - To identify skin epithelial gene signatures from AD skin that are unique and not found in healthy non- AD, NA control skin samples after they are infected ex vivo with HSV-1. A secondary goal of this work will be to evaluate how Real-World treatment(s) affect these observations.

Inclusion criteria

• ≥13 to 65 years of age (inclusive) for PS, ≥13 for AD and NA, male or female
• Optional Bx sub study - only adults (18-65 yrs; inclusive only)
• Able to understand protocol and give consent
• Able to keep clinic/study appointments and comply with study related procedures
• Must be able to read, speak, and understand English
• Chronic AD, according to the American Academy of Dermatology (AAD) Consensus Criteria (Eichenfield 2014), that has been present for at least 1 year before the enrollment visit
• Chronic PS, according to the AAD Consensus Criteria (Menter et al 2008 (section 1)), that has been present for at least 1 year before the enrollment visit.
• AD subjects: have active lesions on upper extremities, lower extremities, or trunk and a total disease severity of high moderate-to-severe (EASI ≥12)
• PS subjects: have active lesions on upper extremities, lower extremities, or trunk and a total disease severity of high moderate-to-severe (PASI ≥7)

Exclusion criteria

• Unwilling and/or unable to complete informed consent process
• <13 or > 65 years of age for PS, >13 for AD and NA
• AD subjects: disease without upper extremity, lower extremity, or trunk lesions
• AD subjects: total disease severity less than moderate (EASI <12), depending on enrollment
• PS subjects: disease without upper extremity, lower extremity, or trunk lesions
• PS subjects: total disease severity less than moderate (PASI <7), depending on enrollment
• Control subjects: diagnosed with an inflammatory skin disease
• Severe concomitant illness(es) that, in the investigator's judgment, would adversely affect the individual's participation in the study (Ex: HIV infection, autoimmune disease, severe heart failure, Hx of malignancy (other than in situ cervical cancer or basosquamous skin cancer), etc.)
• Recent bacterial, fungal, or viral infection requiring systemic therapies (PO, IV or IM) within the last month.
• Subjects with a history of serious life-threatening reaction to tape or adhesives may be enrolled but cannot undergo Tape stripping procedure and will therefore only have a baseline TEWL measurement.
• (For Skin biopsy substudy only) - Subjects with history of keloid formation or allergy to lidocaine.