Staphylococcus aureus Colonization in Acute and Chronic Skin Lesions of Patients with Atopic Dermatitis

Background

Staphylococcus aureus (SA) has peculiar abilities to colonize the skin in atopic dermatitis (AD) patients.

Objective

We sought to determine the colonization rates of SA in acute and chronic skin lesions of AD patients, to find any difference in colonization rates according to age and to find the influences of total immunoglobulin E (IgE) and eosinophil counts to the colonization of SA.

Methods

We evaluated the total IgE level and eosinophil counts, and cultured SA from the skin lesions of 687 AD patients (131 acute and 556 chronic skin lesions) and 247 control urticaria patients (July 2009 to November 2010; Samsung Medical Center Dermatology Clinic, Seoul, Korea).

Results

The SA colonization rates were 74%, 38% and 3% in acute, chronic skin lesions and control skin, respectively, and they were increased with age in AD patients. The colonization rate in chronic skin lesions was higher in the high IgE/eosinophilia groups as compared to the normal IgE/eosinophil groups.

Conclusion

The SA colonization rate was higher in AD patients and especially in acute lesions, and had a tendency to increase with age. As the colonization rates were only higher in the high IgE/eosinophilia groups of chronic skin lesions, we suggested that SA may invade the skin through barrier defects in acute skin lesions, but the colonization in chronic lesions may be orchestrated through many different factors.     

Antibiotic Susceptibility of Staphylococcus aureus in Atopic Dermatitis: Current Prevalence of Methicillin-Resistant Staphylococcus aureus in Korea and Treatment Strategies

Background

Staphylococcus aureus is a well-known microbe that colonizes or infects the skin in atopic dermatitis (AD). The prevalence of methicillin-resistant S. aureus (MRSA) in AD has recently been increasing.

Objective

This study aimed to determine the antimicrobial susceptibility patterns in AD skin lesions and evaluate the prevalence of MRSA in Korea. We also recommend proper first-line topical antibiotics for Korean patients with AD.

Methods

We studied S. aureus-positive skin swabs (n=583) from the lesional skin of infants, children, and adults who presented to our outpatient clinic with AD from July 2009 to April 2012.

Results

S. aureus exhibited high susceptibility against most antimicrobial agents. However, it exhibited less susceptibility to benzylpenicillin, erythromycin, clindamycin, and fusidic acid. The prevalence of MRSA was 12.9% among 583 S. aureus isolates, and the susceptibility to oxacillin was significantly lower in infants in both acute and chronic AD lesions.

Conclusion

S. aureus from AD has a high prevalence of MRSA and multidrug resistance, especially in infants. In addition, the rate of fusidic acid resistance is high among all age groups, and mupirocin resistance increases with age group regardless of lesional status. This is the first study comparing the antimicrobial susceptibility rates of S. aureus isolates from AD cases with respect to age and lesion status in Korea.     

Molecular Analysis of Malassezia Microflora on the Skin of the Patients with Atopic Dermatitis

Background

The yeasts of the genus Malassezia are members of the normal flora on human skin and they are found in 75~80% of healthy adults. Since its association with various skin disorders have been known, there have been a growing number of reports that have implicated Malassezia yeast in atopic dermatitis (AD).

Objective

The aim of the present study is to isolate the various Malassezia species from AD patients by using 26S rDNA (ribosomal Deoxyribonucleic acid) PCR-RFLP and to investigate the relationship between a positive Malassezia culture and the severity of AD.

Methods

Cultures for Malassezia yeasts were taken from the scalp, cheek, chest, arm and thigh of 60 patients with atopic dermatitis. We used a rapid and accurate molecular biological method 26S rDNA PCR-RFLP, and this method can overcome the limits of the morphological and biochemical methods.

Results

Positive Malassezia growth was noted on 51.7% of the patients with atopic dermatitis by 26S rDNA PCR-RFLP analysis. The overall dominant species was M. sympodialis (16.3%). M. restricta was the most common species on the scalp (30.0%) and cheek (16.7%). M. sympodialis (28.3%) was the most common species on the chest. The positive culture rate was the highest for the 11~20 age group (59.0%) and the scalp showed the highest rate at 66.7%. There was no significant relationship between the Malassezia species and SCORing for Atopic Dermatitis (SCORAD).

Conclusion

The fact that the cultured species was different for the atopic dermatitis lesion skin from that of the normal skin may be due to the disrupted skin barrier function and sensitization of the organism induced by scratching in the AD lesion-skin. But there was no relationship between the Malassezia type and the severity score. The severity score is thought to depend not on the type, but also on the quantity of the yeast.     

Two Cases of Infective Endocarditis in Patients with Atopic Dermatitis

Patients with atopic dermatitis have high rates of skin surface colonization of Staphylococcus aureus. At the same time, S. aureus is the major causative organism in infective endocarditis, approximately accounting for 30%~50% cases of infective endocarditis. A 22-year-old male with severe atopic dermatitis presented with fever and myalgia. He was diagnosed with active infective endocarditis causing multiple cerebral infarction, splenic infarction, and septic shoulder requiring synovectomy. Blood culture proved methicillinsensitive Staphylococcus aureus bacteremia, and the culture from the skin revealed same bacteria. After treated with intravenous antibiotics for 6 weeks, patient was improved. Another 42-year-old female with severe atopic dermatitis who presented with fever and chilling was hospitalized due to acute infective endocarditis. She also had left flank pain and visual disturbance, due to splenic infarction and acute cerebral infarction, respectively. As blood culture revealed methicillin-sensitive Staphylococcus aureus bacteremia, she treated with intravenous antibiotics for 6 weeks. The route of entry of two patients was attributed to the patient eczematous scratching lesion of poorly controlled atopic dermatitis. Infective endocarditis can result in the context of acute deterioration of atopic dermatitis. Dermatologists need to pay attention to this risk and actively manage such conditions in order to decrease the risk of infective endocarditis arising from skin lesions in atopic patients. For these reasons, we herein report two cases of infective endocarditis in patients with atopic dermatitis.     

Effect of Emollients Containing Vegetable-Derived Lactobacillus in the Treatment of Atopic Dermatitis Symptoms: Split-Body Clinical Trial

Background

Atopic dermatitis (AD) patients suffer from xerosis. Proper skin care, including the use of emollients, may help improve xerosis and minimize disease exacerbation. Lactobacillus sakei probio 65, isolated from the Korean vegetable-based product kimchi, can decrease interleukin 4 and immunoglobulin E levels and inhibit Staphylococcus aureus. Moreover, it has reportedly shown positive dermatological effects in both animal and clinical studies.

Objective

To compare the effects of an emollient that contains Lactobacillus (treated) with a normal emollient (control) on AD.

Methods

This double-blind, randomized, split-body clinical trial involved 28 patients with AD. The patients applied the Lactobacillus-containing emollient on one side of their body and the control emollient on the other side twice daily for 4 weeks. Trans-epidermal water loss (TEWL) and skin capacitance were evaluated and investigator global assessment and the visual analogue scale (VAS) were administered on weeks 0, 1, 2, and 4.

Results

The treated sides had significantly lower TEWL and VAS values and significantly higher skin capacitance values over time than the control sides.

Conclusion

Topical application of Lactobacillus-containing emollients may improve the skin permeability of patients with AD.     

特应性皮炎患儿皮损局部金黄色葡萄球菌外毒素检测

目的 了解特应性皮炎(AD)患儿皮损局部金黄色葡萄球菌(金葡菌)的带菌率及其分泌外毒素的情况,探讨金葡菌及其分泌的外毒素在AD发病中的作用.方法 AD皮损局部分离金葡菌,反向被动乳胶试验方法检测其外毒素表达,并与对照组进行统计学比较.结果 与对照组相比,AD患儿无论是皮损局部还是非皮损区金葡菌带菌率明显升高(P值均<0.01),且与疾病严重性呈正相关性(P<0.01).但AD皮损局部的金葡菌与对照组金葡菌相比,两者分泌外毒素的情况差异无显著性(P>0.05),并且皮损局部的金葡菌是否分泌外毒素与疾病严重性无直接相关性(P>0.05),但伴有血清总IgE水平升高的AD患儿,疾病相对较重(P<0.01).结论 AD患儿皮损区金葡菌带菌率为43.24%,其中47.46%分泌外毒素,以金葡菌肠毒素B(SEB)最常见.     

Community-associated methicillin-resistant Staphylococcus aureus skin infections in the tropics

Skin and soft tissue infections (SSTI) caused by Staphylococcus aureus are very common, particularly in children, in tropical regions. The proportion of S aureus SSTI caused by community-associated methicillin-resistant S aureus (CA-MRSA) varies according to region, but is up to 25% in some areas. There are diverse CA-MRSA clones, including several that harbor Panton-Valentine leukocidin. Key predisposing factors for staphylococcal infections are scabies infestation, overcrowding, poor hygiene, and inadequate water supplies. In the setting of a community outbreak of staphylococcal SSTI, interventions intended to improve personal and community hygiene are likely to be the most practical, effective, and achievable. Options for oral treatment of clinical infections caused by CA-MRSA include clindamycin and trimethoprim-sulfamethoxazole. Although rapid diagnostics are now available, and 2 vaccines have reached clinical trials, neither of these is likely to be of use in tropical, developing regions in the near future.     

中间丝聚合蛋白在特应性皮炎患者皮损中的表达

目的：探讨中间丝聚合蛋白（Filaggrin,FLG）在特应性皮炎（Atopic dermatitis,AD）患者皮损的表达及其临床意义。方法：采用sP免疫组化方法检测16例AD患者皮损及14例对照组皮肤组织内FLG的表达,用图像分析软件Image-ProPlus（IPP）判定FLG在AD患者皮损及健康者皮肤组织中阳性染色面积百分比。结果：FLG在AD患者皮损及健康者皮肤角质层及颗粒层均有表达,胞质染色多见;阳性染色面积百分比分别为（18．92±4．40）％及（23．00±2．28）％;FLG在AD患者皮损阳性染色面积明显低于健康人皮肤（t=－3．11,P=0．004）。结论：FLG在AD患者皮损中表达降低,可能是导致AD患者皮肤屏障功能障碍的原因。     

特应性皮炎患儿过敏原检测及分析

目的了解延边地区特应性皮炎患儿过敏原种类,为制定预防措施提供依据。方法采用免疫印迹法检测200例特应性皮炎患儿血清特异性IgE(sIgE)和IgE,并对朝鲜族和汉族患儿的检测结果进行比较。结果婴幼儿组59例(朝鲜族26例,汉族33例)和小儿组55例(朝鲜族28例,汉族27例)血清总IgE升高,婴幼儿组血清特异性IgE阳性53例(朝鲜族24例,汉族29例),小儿组有58例(朝鲜族30例,汉族28例),两年龄组间及两民族间差异均无统计学意义(P均>0.05)。两组患儿阳性率较高的过敏原依次为牛奶、牛肉和羊肉。结论延边地区婴幼儿组和小儿组特应性皮炎患儿血清总IgE水平和血清特异性IgE阳性率差异不显著,且朝鲜族和汉族患儿也无差异,特异性过敏原主要为牛奶、牛肉和羊肉。     

湿疹和特应性皮炎皮损处细菌定植情况及药物联合治疗的分析

目的 探讨湿疹和特应性皮炎(AD)皮损处金黄色葡萄球菌(金葡菌)及其他细菌的定植情况,评价抗菌药物与糖皮质激素联合用药的疗效。方法 采用多中心、随机、双盲试验,在筛选日及治疗后第7、14和28天对皮损评分,并在皮损和非皮损处分离细菌。试验组外用抗菌药物和糖皮质激素,对照组外用基质和糖皮质激素。结果 共入选患者327例,湿疹208例,AD119例。湿疹皮损处细菌的阳性率为70.19%,金葡菌占47.26%;非皮损部位细菌阳性率为32.69%,金葡菌占27.94%。AD皮损处细菌阳性率为74.79%,金葡菌占79.78%;非皮损部位细菌阳性率为34.45%,金葡菌占80.49%。湿疹和AD皮损部位金葡菌的定植量均高于非皮损部位(P<0.01,P<0.05),细菌的定植量与皮损的严重程度呈正相关。两组患者治疗后总体疗效无明显差异(P>0.05),但湿疹临床症状评分指数>8分者及AD评分指数>7分者,在治疗的第7天,试验组与对照组的症状评分指数改善率存在显著差异(P<0.05),在治疗的第14天和第28天,两组差异均无显著性(P>0.05)。结论 湿疹和AD患者皮损部位细菌的检出率和金葡菌的带菌率均明显增高,说明金葡菌与湿疹皮炎的关系密切,早期联用抗菌药物可提高疗效。     

Current Understanding in Pathogenesis of Atopic Dermatitis

There have been advances in our understanding of the complex pathogenesis of atopic eczema over the past few decades. This article examines the multiple factors which are implicated in this process.     

Food Hypersensitivity in Patients Over 14 Years of Age Suffering from Atopic Dermatitis

Background:

Patients suffering from atopic dermatitis often describe food hypersensitivity. Rising prevalence of food hypersensitivity and severe allergic reactions to foods have been reported, but the data are scarce.

Aims and Objectives:

Evaluation of food hypersensitivity reactions in patients suffering from atopic dermatitis.

Materials and Methods:

The dermatological examination was performed in patients of age 14 years and above and the detailed history was taken concerning the food hypersensitivity.

Results:

A total of 228 patients were examined-72 men, 156 women, average age 26.2 (SD 9.5) years. The food hypersensitivity reactions were recorded in 196 patients from 228 (86%), no reactions were recorded in 32 patients (24%). Foods with the most often recorded reactions are: Nuts (in 35% of patients), tomatoes (in 20%), and kiwi (in 17, 5%), apples and spices (in 16%), tangerines and oranges (in 15%), capsicum (in 13%), fishes (in 12%), celery (in 9%), and chocolate (in 7%).

Conclusion:

Food hypersensitivity reactions are recorded in 86% of patients suffering from atopic dermatitis. Nuts, tomatoes, and pollen–associated foods play a role in the majority of patients suffering from atopic dermatitis.     

特应性皮炎患者生活质量及心理特征调查分析

目的调查特应性皮炎(AD)患者生活质量、焦虑、抑郁情况及其影响因素,为提高AD患者生活质量提供相应理论支持。方法采用手机扫描二维码登陆腾讯问卷平台,填写皮肤病生活质量指数(DLQI)和焦虑(SAS)、抑郁(SDS)程度自评表,对527例AD患者进行问卷调查,评估其生活质量与焦虑抑郁心理特征,使用方差分析和logistic回归分析其影响因素。结果问卷调查结果通过logistic分析,生活质量主要影响因素包括年龄、学历、职业;中-高度焦虑症主要影响因素为民族、婚姻;中-高度抑郁症主要影响因素是婚姻状况、学历。皮肤病生活质量影响程度,焦虑程度和抑郁程度三者进行Sperman秩相关分析显示,三者两两正相关。结论AD影响患者生活质量,并且给患者心理带来严重的负面影响。     

Comparative Analysis of Cutaneous Fungi in Atopic Dermatitis Patients and Healthy Individuals

BackgroundAtopic dermatitis (AD) is a chronic relapsing inflammatory skin disease triggered by diverse factors. Microbes are one of the crucial risk factors for AD development or exacerbation. However, the effect of a fungal burden on AD has been overlooked compared to bacteria.ObjectiveThis study aimed to comparatively analyze cutaneous fungal distribution between AD patients and healthy individuals by polymerase chain reaction (PCR)-based analysis.MethodsSkin samples of AD outpatients and healthy individuals collected at the Chung-Ang University were analyzed. Representative AD-associated fungal genera, Candida, dermatophytes, and Malassezia , were analyzed using specific primer and amplification methods. Amplicons were sequenced, and the fungal distribution of both groups were compared.ResultsTotally, 211 patients and 23 healthy individuals were studied. Of the 211 patients, 10.90% (23/211) had Candida species, whereas 0% (0/23) healthy individuals showed its presence. The most frequently detected species in patients was Candida albicans (5.21%) followed by Candida parapsilosis (3.79%). For dermatophytes, 1.42% (3/211) of patients showed positive results, whereas 0% (0/23) healthy individuals showed positive results. Malassezia species were identified in 20.85% (44/211) and 8.70% (2/23) in patients and healthy individuals, respectively. Malassezia restricta was the most frequently identified species in the AD patient group, and the only species found in the healthy control group.ConclusionThe distribution of Candida spp., dermatophytes, and Malassezia spp. are altered with AD development.     

特应性皮炎和慢性荨麻疹患者皮肤点刺试验检查结果分析

目的:了解皮肤点刺试验对特应性皮炎和慢性荨麻疹患者的临床意义。方法:对进行皮肤点刺试验的33例特应性皮炎和20例慢性荨麻疹患者的结果进行总结分析。结果:在特应性皮炎和慢性荨麻疹患者中均以粉尘螨(分别为78.79%,75.00%)和屋尘螨(分别为75.76%,70.00%)的阳性率最高,粉尘螨和屋尘螨在两者中的阳性率比较,差异均有统计学意义(χ2=9.04,P<0.05;χ2=12.35,P<0.05)。牛奶在慢性荨麻疹患者中的阳性率(30.00%)高于在特应性皮炎患者中的阳性率(6.06%),差异有统计学意义(χ2=8.00,P<0.05)。结论:特应性皮炎患者较慢性荨麻疹患者对粉尘螨、屋尘螨更易过敏,而后者较前者对牛奶更易过敏。进行皮肤点刺试验可以有效寻找过敏原,减少病情反复机会。     

The Effect of Hypoallergenic Diagnostic Diet in Adolescents and Adult Patients Suffering from Atopic Dermatitis

Aim:

To evaluate the effect of a diagnostic hypoallergenic diet on the severity of atopic dermatitis in patients over 14 years of age.

Materials and Methods:

The diagnostic hypoallergenic diet was recommended to patients suffering from atopic dermatitis for a period of 3 weeks. The severity of atopic dermatitis was evaluated at the beginning and at the end of this diet (SCORAD I, SCORAD II) and the difference in the SCORAD over this period was statistically evaluated.

Results:

One hundred and forty-nine patients suffering from atopic dermatitis were included in the study: 108 women and 41 men. The average age of the subjects was 26.03 (SD: 9.6 years), with the ages ranging from a minimum of 14 years to a maximum of 63 years. The mean SCORAD at the beginning of the study (SCORAD I) was 32.9 points (SD: 14.1) and the mean SCORAD at the end of the diet (SCORAD II) was 25.2 points (SD: 9.99). The difference between SCORAD I and SCORAD II was evaluated with the Wilcoxon signed-rank test. The average decrease of SCORAD was 7.7 points, which was statistically significant (P=.00000).

Conclusion:

Introduction of the diagnostic hypoallergenic diet may serve as a temporary medical solution” in patients suffering from moderate or severe forms of atopic dermatitis. It is recommended that this diet be used in the diagnostic workup of food allergy.     

特应性皮炎全基因组病学及相关候选基因的研究进展

特应性皮炎(AD)是一种常见的慢性反复性炎症皮肤疾病。遗传因素是特应性皮炎发生、发展的重要因素。目前,AD遗传易感基因位点及相关候选基因的研究已取得一定的进展,通过全基因组连锁分析等方法发现染色体3p26-22,3q13-21,15q14-21,17q21-25和18q11-12区域存在AD易感位点及相关候选基因,并与特应性皮炎发病密切相关。这些研究有利于进一步加深对AD发病机制的认识,并可能为AD的治疗提供新的方向。     

银川地区儿童特应性皮炎529例常见过敏原分析

目的了解宁夏银川地区儿童特应性皮炎的常见过敏原,以针对性指导其预防和治疗。方法应用德国百康(BICOM 2000)生物共振仪对529例儿童特应性皮炎患儿进行常见过敏原检测。结果共检测过敏原647种,阳性例数为4538例次;其中检出阳性率5.00%的常见过敏原27种,阳性例数3070例次,占全部阳性例数的67.65%。排前十位的常见过敏原依次是屋尘螨(阳性例数358例,阳性率67.67%),鱼类混合物315例(59.55%),蛋白蛋黄217例(41.02%),粉尘螨203例(38.37%),酒石酸185例(34.97%),羊肉178例(33.65%),甲醛147例(27.79%),牛奶141例(26.65%),动物皮毛136例(25.71%)和苯胺113例(21.36%)。结论目前本地区儿童特应性皮炎的过敏原多是鱼类混合物、蛋白蛋黄、羊肉等食物,尘螨、花粉、动物皮毛等吸入物,以及甲醛和苯胺等化学物质,应该引起社会、家长和孩子们的充分重视。