Figure 1.

Changes in the fungal microbiome after dupilumab administration. Thirty lesion sites on the foreheads of patients were analyzed. (a) Abundant fungal genera. Genera with a relative abundance of >2% are shown. The relative abundance of Malassezia restricta decreased after dupilumab administration, whereas that of M. globosa increased. (b) Relative abundance of three taxonomic categories. The relative abundances of the Malassezia species were lower than those of the non-Malassezia yeasts and filamentous fungi. (c) Relative abundance of Candida albicans, ** p < 0.01. (d) Shannon diversity of the bacterial microbiome. Diversity increased 2 weeks after dupilumab administration. ** p < 0.01. (e–g) Changes in degree of skin colonization by Malassezia revealed using qPCR. (e) Overall Malassezia species. (f) M. restricta. (g) M. globosa. The degree of skin colonization by overall Malassezia, M. restricta, and M. globosa decreased compared to baseline. Experiments were performed in triplicate for each sample, ** p < 0.01. (h) Correlation between reduction rate related to baseline and degree of skin colonization by Malassezia species (r² = 0.26). HS, healthy subjects.