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Skin pH-dependent Staphylococcus aureus abundance as predictor for increasing atopic dermatitis severity.

Claudia Hülpüsch1, Karolina Tremmel1, Gertrud Hammel1

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Summary

High Staphylococcus aureus (S. aureus) in atopic dermatitis (AD) is linked to elevated skin pH and predicts increased disease severity. Maintaining a healthy skin pH may help manage S. aureus levels and AD progression.

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Area of Science:

  • Dermatology
  • Microbiology
  • Biophysics

Background:

  • Atopic dermatitis (AD) is marked by a compromised skin barrier, elevated skin pH, and dysbiosis of the skin microbiome.
  • Increased Staphylococcus aureus (S. aureus) colonization, particularly during flares, is a common feature of AD.
  • S. aureus exhibits optimal growth at neutral pH, suggesting a potential link between skin pH and bacterial load in AD.

Purpose of the Study:

  • To investigate the longitudinal relationship between skin pH, skin microbiome composition, and atopic dermatitis severity.
  • To explore the interplay between S. aureus abundance, skin pH, and disease progression in a pilot study.

Main Methods:

  • A pilot study involving 6 AD patients and 6 healthy controls (HE).
  • Application of emollients with either basic (pH 8.5) or acidic (pH 5.5) pH twice daily for 8 weeks.
  • Weekly assessments included skin swabs for microbiome analysis, AD severity scoring (EASI, local SCORAD), and skin physiology measurements (pH, hydration, transepidermal water loss).

Main Results:

  • Emollient pH did not show a robust correlation with physiological, microbiome, or clinical outcomes.
  • In contrast to HE subjects with stable microbiomes, S. aureus frequency significantly increased in AD patients over 8 weeks.
  • High S. aureus abundance correlated with skin pH levels between 5.7-6.2.
  • Elevated baseline S. aureus frequency predicted subsequent increases in both S. aureus colonization and AD severity.

Conclusions:

  • Intrinsic factors tightly regulate skin pH, which in turn limits S. aureus abundance.
  • High baseline S. aureus colonization is a predictor of increased AD severity over time.
  • Further large-scale studies are warranted to elucidate the complex interplay between skin pH, S. aureus, and AD pathogenesis to inform therapeutic strategies.