Staphylococcus spp. skin colonization in anti-IL-4/IL-13 and anti-JAK- treated atopic dermatitis patients: proposal of a standardized protocol for research and clinical applications

Atopic dermatitis (AD) is a chronic inflammatory autoimmune skin disease, characterized by intense pruritus, eczematous lesions, microbiota dysbiosis and skin barrier dysfunction, affecting million people worldwide. These alterations facilitate microbial overcolonization and virulence, mainly by the opportunistic pathogen Staphylococcus aureus (SA), contributing to the disease severity. Novel biologic systemic treatments, wherein the anti-IL-4/IL-13 Dupilumab antibody and the JAK inhibitor Upadacitinib, changed the therapeutic scenario3. Since Staphylococcus spp. role in AD is still poorly understood, it must be clarified if the increased levels precede symptoms, contributing to the inflammation onset or are a consequence. Therefore, this pilot study proposes a standardized procedure to monitor Staphylococcus spp., mainly SA skin colonization during treatment, to likely clarify the potential interactions with the drug mechanisms of action, predict therapy response, and create interactive databases. Swabs from lesional and non-lesional skin, collected with validated protocols, are both bio-banked and let them growth onto selective/differential media for Staphylococcus spp cultural assessment and their DNA isolated for 16SrRNA sequencing for bacterial diversity identification and comparison. The findings obtained with the proposed protocol could lay the basis for its possible integration in the clinical practice, for a more accurate diagnosis and a better personalized management of the disease.