Background Patients with atopic dermatitis (AD) are prone to skin infections, with microbes like Staphylococcus aureus suspected of contributing to pathogenesis. Bleach baths might improve AD by reducing skin microbial burden. Objective To characterize the microbiota of lesional and nonlesional skin in young children with AD and controls and compare changes after treatment with a topical corticosteroid (TCS) alone or TCS + dilute bleach baths (BB). Methods In a randomized, placebo-controlled, single-blinded clinical trial in 21 children with AD and 14 healthy children, lesional and nonlesional AD skin was examined at baseline and after 4-week treatment with TCS alone or TCS plus BB. Microbial DNA was extracted for qPCR of predominant genera and 16S rRNA sequencing. Results At baseline, densities of total bacteria and Staphylococcus, including S. aureus, were significantly higher at the worst AD lesional site than nonlesional (p=0.001) or control (p<0.001) skin; bacterial communities on lesional and nonlesional AD skin significantly differed from each other (p=0.04) and from control (p<0.001). After TCS + BB or TCS alone, bacterial compositions on lesional skin normalized (p<0.0001), resembling nonlesional skin, with microbial diversity restored to control skin levels. Limitations The 4-week time period and/or the twice-weekly baths may not have been sufficient for additional impact on the cutaneous microbiome. More detailed sequencing may allow better characterization of the distinguishing taxa with BB-treatment. Conclusions Treatment with a topical corticosteroid cream suffices to normalize the cutaneous microbiota on lesional AD; after treatment, bacterial communities on lesional skin resemble nonlesional skin but remain distinct from control.

AGA is the most common form of hair loss in adolescents, and can be the presenting sign of an underlying endocrine disorder. An accurate and timely diagnosis is essential for appropriate medical and psychosocial intervention when warranted.

Patients with SPS have an increased risk of CRC, although lower than previously published. Close colonoscopy surveillance in experienced centres show a low risk of developing CRC (1.9% in 5 years). Specific polyp features (SSA/P histology, proximal location and presence of high-grade dysplasia) should be used to guide clinical management.

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