TCL-036: Alternations in the Skin Microbiota Are Associated with Symptom Severity in Mycosis Fungoides

Context Mycosis fungoides (MF) is the most common subtype of cutaneous T-cell lymphoma (CTCL). Recently Staphylococcus aureus colonization of the cutaneous lesions has been implicated in the pathogenesis. The role of skin microbiota in the symptom’s manifestation of CTCL remains unclear. Objective To characterize the regional skin microbiota changes in patients with MF and to identify skin microbial signatures associated with various symptoms and their severity. Design Prospective pilot cross-sectional study of 39 patients with MF treated at CTCL interdisciplinary clinic at Moffitt Cancer Center from March 2019 to June 2019. Skin microbial samples were taken from the lesional skin and the contralateral nonlesional healthy skin from the same patient. 16S ribosomal RNA sequencing was performed on the samples. Setting Tertiary referral center. Patients or Other Participants Thirty-nine patients with active biopsy-confirmed MF lesions were included. Patients with active skin infections or recent systemic or topic antibiotics use were excluded. Interventions None. Main Outcome Measures Alpha diversity was measured using Shannon entropy and compared using the Wilcoxon signed-rank test. Beta diversity was visualized with a principal components analysis. The relative abundance of the OUT was compared between lesional and matched nonlesional skin using a T-test. The differences in genus-relative abundance in skin microbiota between the lesional and nonlesional skin were used to reflect changes. The changes in genus-relative abundance were correlated with the scores for symptoms. Results Lesional skin appeared to have less bacterial diversity and richness than nonlesional skin, although differences were not statistically significant. Microbiota signatures associated with different symptoms or signs were identified. An increase in Staphylococcus in lesional skin was especially associated with pronounced erythema, and a decrease in Propionibacterium in lesional skin was associated with increased pain and skin thickness. Conclusions Our findings suggest a potential microbial role in changing disease phenotypes among patients with CTCL. Larger studies of the skin microbiota in patients with MF may further characterize these differences and support antibiotic treatments to mitigate CTCL symptoms and perhaps prevent disease progression.