Crisaborole Reduced the Staphylococci but Increased Cutibacterium on the Skin Microbiome of Children with Atopic Dermatitis

Abstract

Background:

Atopic dermatitis (AD) is a common, recurrent skin disease in children, associated with an imbalance in the skin microbiome. Topical corticosteroids (TCS) cream is the first-line drug for treating AD. However, its long-term use is prone to the development of adverse reactions. Crisaborole, a nonsteroidal medication, is effective and well-tolerated for long-term maintenance treatment and flare reduction in adult and pediatric patients with mild-to-moderate AD. However, the effect of crisaborole on the skin microbiome remains unknown.

Objective:

The study aimed to compare the effects of topical crisaborole treatment and TCS treatment on microbial abundance and diversity in AD lesions.

Methods:

A cross-sectional study was conducted involving 30 children with mild-to-moderate AD and 10 healthy controls. Patients with AD were divided into three groups (untreated, TCS, and crisaborole; n = 10 each) based on baseline status. Skin samples were collected directly from the healthy child, the untreated lesions, and after a 2-week treatment period. The skin microbiome was analyzed using 16S rRNA gene sequencing.

Results:

Compared to the untreated AD group, both TCS and crisaborole treatments significantly reduced the relative abundances of Staphylococcus and Pseudomonas, while increasing the abundances of Streptococcus and Cutibacterium (formerly Propionibacterium). Alpha diversity of the skin microbiome was significantly increased after both treatments. However, the microbial profile of the crisaborole group was more distinct from the healthy control group than the TCS group was. Furthermore, the crisaborole group showed significant enrichment of taxa from the phylum Actinobacteria, including the genus Cutibacterium and species acnes.

Conclusions:

Although the efficacy of crisaborole in treating mild-to-moderate AD in children is not equivalent to that of TCS, crisaborole could still remarkably improve the clinical symptoms of patients and partially restore the microbial diversity on the skin surface of children with AD.