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We aimed to investigate associations among AD patients' skin microbiome, clinical data, and response to systemic therapy in patients of the TREATgermany registry.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Skin swabs of 157 patients were profiled with 16S rRNA gene amplicon sequencing before and after 3\u2009months of treatment with dupilumab or cyclosporine. For comparison, 16s microbiome data from 258 population\u2010based healthy controls were used. Disease severity was assessed using established instruments such as the Eczema Area and Severity Index (EASI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We confirmed the previously shown correlation of<jats:italic>Staphylococcus aureus<\/jats:italic>abundance and bacterial alpha diversity with AD severity as measured by EASI. Therapy with Dupilumab shifted the bacterial community toward the pattern seen in healthy controls. The relative abundance of Staphylococci and in particular<jats:italic>S. aureus<\/jats:italic>significantly decreased on both lesional and non\u2010lesional skin, whereas the abundance of<jats:italic>Staphylococcus hominis<\/jats:italic>increased. These changes were largely independent from the degree of clinical improvement and were not observed for cyclosporine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Systemic treatment with dupilumab but not cyclosporine tends to restore a healthy skin microbiome largely independent of the clinical response indicating potential effects of IL\u20104RA blockade on the microbiome.<\/jats:p><\/jats:sec>","DOI":"10.1111\/all.15742","type":"journal-article","created":{"date-parts":[[2023,4,10]],"date-time":"2023-04-10T03:39:48Z","timestamp":1681097988000},"page":"2290-2300","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":51,"title":["Dupilumab but not cyclosporine treatment shifts the microbiome toward a healthy skin flora in patients with moderate\u2010to\u2010severe atopic dermatitis"],"prefix":"10.1111","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1842-8219","authenticated-orcid":false,"given":"Jan","family":"Hartmann","sequence":"first","affiliation":[{"name":"Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy University Hospital Schleswig\u2010Holstein, Campus Kiel Kiel Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"Moitinho\u2010Silva","sequence":"additional","affiliation":[{"name":"Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy University Hospital Schleswig\u2010Holstein, Campus Kiel Kiel Germany"},{"name":"Institute of Clinical Molecular Biology Kiel University Kiel Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9084-7069","authenticated-orcid":false,"given":"Nicole","family":"Sander","sequence":"additional","affiliation":[{"name":"Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy University Hospital Schleswig\u2010Holstein, Campus Kiel Kiel Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inken","family":"Harder","sequence":"additional","affiliation":[{"name":"Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy University Hospital Schleswig\u2010Holstein, Campus Kiel Kiel Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"H\u00e4sler","sequence":"additional","affiliation":[{"name":"Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy University Hospital Schleswig\u2010Holstein, Campus Kiel Kiel Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elke","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy University Hospital Schleswig\u2010Holstein, Campus Kiel Kiel Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Haufe","sequence":"additional","affiliation":[{"name":"Center of Evidence\u2010Based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus TU Dresden Dresden Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Kleinheinz","sequence":"additional","affiliation":[{"name":"Clinics for Dermatology Elbe Klinikum Buxtehude Buxtehude Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Abraham","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Medical Faculty Carl Gustav Carus, University Allergy Center TU Dresden Dresden Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annice","family":"Heratizadeh","sequence":"additional","affiliation":[{"name":"Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy Hannover Medical School Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elke","family":"Weisshaar","sequence":"additional","affiliation":[{"name":"Division of Occupational Dermatology, Department of Dermatology Ruprecht\u2010Karls University Heidelberg Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Knut","family":"Sch\u00e4kel","sequence":"additional","affiliation":[{"name":"Department of Dermatology Ruprecht\u2010Karls University Heidelberg Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christiane","family":"Handrick","sequence":"additional","affiliation":[{"name":"Practice Dr. med. 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