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. 2025 Jun;39(6):1118-1125.
doi: 10.1111/jdv.20366. Epub 2024 Oct 3.

Hand eczema and changes in the skin microbiome after 2 weeks of topical corticosteroid treatment

Line Brok Nørreslet  1   2 , Anna Cäcilia Ingham  3 , Tove Agner  1 , Caroline Meyer Olesen  1 , Anne Bregnhøj  4 , Mette Sommerlund  4 , Paal Skytt Andersen  3 , Marc Stegger  3   5 , Charlotte Gotthard Mørtz  2 , Sofie Marie Edslev  3
Affiliations

Hand eczema and changes in the skin microbiome after 2 weeks of topical corticosteroid treatment

Line Brok Nørreslet et al. J Eur Acad Dermatol Venereol. 2025 Jun.

Abstract

Background: More than 50% of patients with hand eczema (HE) are colonized with Staphylococcus aureus. Comprehensive knowledge of the skin microbiome and its changes in patients with HE may provide insights into future potential therapeutical targets.

Objective: To describe the skin microbiome in patients with moderate-to-severe chronic HE and assess its changes following treatment with topical corticosteroids (TCS).

Methods: Bacterial samples were collected from lesional and nonlesional skin before and after 2 weeks of TCS treatment using ESwabs and analysed by 16S rRNA and tuf gene sequencing. Clinically, the disease severity was assessed by the Hand Eczema Severity Index (HECSI).

Results: A cohort of 31 patients with HE were included and followed up. Compared to nonlesional skin, lesional skin differed in overall bacterial community composition (p = 0.02), displayed higher relative abundance of Staphylococcus, in particular S. aureus (p = 0.01) and lower abundance of Micrococcus (p = 0.02). As disease severity improved with treatment, these microbial characteristics on lesional skin shifted towards that of nonlesional skin on the hands.

Conclusions: The bacterial skin microbiome was altered in lesions of HE and partly driven by S. aureus colonization, however, shifted towards nonlesional skin following treatment. Our results emphasize the future possibilities for anti-S. aureus treatment strategies.

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Conflict of interest statement

LB Nørreslet, AC Ingham, PS Andersen, M Stegger, CG Mørtz, A Bregnhøj and SM Edslev have none to declare. T Agner: Involved with AbbVie, LEO Pharma A/S, Pfizer, Sanofi, Eli Lilly, Galderma by grants, consulting fees, lectures. Advisory Board for AbbVie, Eli Lilly, LEO Pharma A/S and Sanofi. CM Olesen: Employed as industrial postdoc at LEO Pharma and Bispebjerg Hospital. M Sommerlund: PI on Leo study DELTA2 og 3, not related to this study. Abbvie grant for participation in EADV congress 2022 and 2023. Leo‐Pharma advisory board for Delgocitinib 2024.

Figures

FIGURE 1
FIGURE 1
Bacterial community composition in patients with hand eczema. Principal component analysis (PCA) biplot illustrating the bacterial diversity at the genus level. Small points indicate samples coloured by sample site and timepoint and bigger points indicate the mean point of the group with corresponding 95% confidence levels. Arrows indicates the four taxa contributing most to the observed variance in the data. The variance captured by the first dimension (24.2% of the total variance) largely separated samples collected at LS prior to topical corticosteroid treatment from the other sample groups (LS post treatment, NLS prior to treatment and NLS post treatment), with Staphylococcus contributing most to the observed variance in this dimension (61.3%). LS, lesional skin; NLS, nonlesional skin; POST, post topical corticosteroid treatment; PRE, prior to topical corticosteroid treatment.
FIGURE 2
FIGURE 2
The relative abundance of bacteria in patients with hand eczema. Bar plots illustrating the relative abundance of the 10 most abundant (a) bacterial genera and (b) staphylococcal species on lesional skin (LS) and nonlesional skin (NLS) before (PRE) and after (POST) 2 weeks of treatment with a potent topical corticosteroid. Patients are listed in the same order in all eight panels and sorted by the relative abundance of Staphylococcus within LS prior to treatment.
FIGURE 3
FIGURE 3
Within‐patient changes in bacterial community structure followed by TCS treatment. Boxplot illustrating the intra‐individual differences in the bacterial community composition (genus level) calculated using Bray–Curtis dissimilarities at each sample site, that is, lesional and nonlesional skin, respectively. A pairwise test (Mann–Whitney U‐test) of the dissimilarities between the sample sites showed a more pronounced change in bacterial composition on lesional compared with nonlesional skin following treatment. Boxplots represent the median and interquartile range (IQR) with whiskers extending to the minimum/maximum value, but no longer than 1.5xIQR. LS, lesional skin; NLS, nonlesional skin; POST, post topical corticosteroid treatment; PRE, prior to topical corticosteroid treatment.
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