NIH study sheds new light on bacteria therapy for eczema
Tuesday, August 07, 2018
Not only do the embarrassing patches of rough, reddened eczema erode self-esteem, the intense itching often leads to infection that requires treatment with antibiotics. Living with this inflammatory skin disease can be emotionally and physically challenging.
Eczema is a disease group that encompasses a few forms of dermatitis, both endogenous (atopic dermatitis) and exogenous (irritant and allergic contact dermatitis).
Approximately 31.6 million Americans have symptoms of eczema, including 17.8 million with symptoms of atopic dermatitis. Worldwide, about 20 percent of children and up to 3 percent of the adult population have some form of eczema.
Based on a survey by the United States Centers for Disease Control and Prevention, the prevalence of eczema among children younger than age 18 rose between 2000 and 2010 from 9 percent to 17 percent among black children, from 5 percent to 10 percent among Hispanic children, and from 8 percent to almost 13 percent among white children.
The current medical treatments with antihistamines, antibiotics, and topical steroid creams focus on reducing itching and swelling, and only focus on making the symptoms more bearable. Some of these treatments come at the cost of nasty side effects.
According to Dr. Anthony S. Fauci, director of NIH’s National Institute of Allergy and Infectious Diseases (NIAID), new and inexpensive therapies that require less frequent application are needed to expand the options available for atopic dermatitis treatment.
While the cause of atopic dermatitis is unknown, studies suggest that the skin microbiome — the community of bacteria and other microbes living on the skin — plays a key role, and scientists have known that people with atopic dermatitis tend to have large populations of Staphylococcus aureus bacteria on their skin.
These bacteria can cause skin infections and trigger immune responses that increase inflammation and worsen symptoms.
Recent work by NIAID researchers using mouse and cell culture models of atopic dermatitis revealed that treatment with isolates of Roseomonas mucosa collected from the skin of healthy people improved disease outcomes in the models. In contrast, R. mucosa isolates from people with atopic dermatitis either had no impact or worsened outcomes in the models.
In this study, enrolled patients underwent history, screening blood work, bacterial antecubital skin swab, and assessment of antecubital-specific and total scoring of atopic dermatitis (SCORAD) values. Patients self-administered the topical, live bacteria in a predetermined dose escalation from 103-105 colony-forming units per site.
Treatments were twice per week for all adults and for weeks 0-12 for the pediatric cohort. Pediatric patients administered treatments every other day during weeks 13-16. Treatments consisted only of R. mucosa in 250 μl of 10 percent to 15 percent sucrose.
Remote follow-up for solicitation of unexpected problems and/or adverse events was performed weekly during adult treatment and then 4 weeks after discontinuation of therapy. There were no complications or adverse effects, and most participants experienced improvements in their eczema, including a reduced need for topical steroids.
The researchers also found that treatment was associated with decreases in the S. aureus population on the children's skin.The investigators observed a greater than 50 percent improvement in atopic dermatitis severity in 4 of 5 children and 6 of 10 adults. Larger studies comparing the bacteria therapy with a placebo will be required to assess the effectiveness of this potential treatment.
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