26 Microbiology in Atopic Eczema

A targeted topical antibiotic treatment in AE can be indicated in localized nummular eczema which often responds nicely to the combination of anti-inflammatory and antibacterial therapy. Suitable agents are mupirocin, fusidic acid and retapamulin. While in some countries there is a tendency to reserve mupirocin for eradication strategies in intensive care units and high-risk medical centres, others continue to use mupirocin as routine medication for infected skin disease. Fusidic acid is commonly used for cutaneous Staph. aureus infection but resistance is increasingly induced and in several areas, up to 50% show unresponsiveness [52]. Whether this in vitro resistance is also clinically relevant or whether it can be overcome by increased doses of fusidic acid remains a matter of debate. Retapamulin is a drug recently introduced for the treatment of cutaneous Staph. aureus infection which also shows excellent efficacy against streptococci for which the induction of resistance patterns has not yet been documented [53].


1 Leyden JJ, Marples RR, Kligman AM. Staphylococcus aureus in the lesions of atopic dermatitis. Br J Dermatol 1974;90(5):525–30.

2 Aly R, Maibach HI, Shinefield HR. Microbial flora of atopic dermatitis. Arch Dermatol 1977;113(6):780–2.

3 Mempel M, Lina G, Hojka M et al. High prevalence of superantigens associated with the egc locus in Staphylococcus aureus isolates from patients with atopic eczema. Eur J Clin Microbiol Infect Dis 2003;22(5):306–9.

4 Breuer K, Kapp A, Werfel T. Staphylococcus aureus: colonizing features and influence of an antibacterial treatment in adults with atopic dermatitis. Br J Dermatol 2002;147(1):55–61.

5 Hoeger PH, Lenz W, Boutonnier A, Fournier JM. Staphylococcal skin colonization in children with atopic dermatitis: prevalence, persistence, and transmission of toxigenic and nontoxigenic strains. J Infect Dis 1992;165(6):1064–8.

6 Cho SH, Strickland I, Tomkinson A, Fehringer AP, Gelfand EW, Leung DY. Preferential binding of Staphylococcus aureus to skin sites of Th2-mediated inflammation in a murine model. J Invest Dermatol 2001;116(5):658–63.

7 Kisich KO, Carspecken CW, Fieve S, Boguniewicz M, Leung DY. Defective killing of Staphylococcus aureus in atopic dermatitis is associated with reduced mobilization of human beta-defensin-3. J Allergy Clin Immunol 2008;122(1):62–8.

8 Mrabet-Dahbi S, Dalpke AH, Niebuhr M et al. The Toll-like receptor 2 R753Q mutation modifies cytokine production and Toll-like receptor expression in atopic dermatitis. J Allergy Clin Immunol 2008;121(4):1013–19.

9 Bunikowski R, Mielke ME, Skarabis H et al. Evidence for a disease-promoting effect of Staphylococcus aureus-derived exotoxins in atopic dermatitis. J Allergy Clin Immunol 2000;105(4):814–19.

10 Dahl MV. Staphylococcus aureus and atopic dermatitis. Arch Dermatol 1983;119(10):840–6.

11 Williams RE, Gibson AG, Aitchison TC, Lever R, Mackie RM. Assessment of a contact-plate sampling technique and subsequent quantitative bacterial studies in atopic dermatitis. Br J Dermatol 1990;123(4):493–501.

12 Leung D. Role of Staphylococcus aureus in atopic dermatitis. In: Bieber TL (ed) Atopic dermatitis, vol. 1. New York: Marcel Dekker, 2002.

13 Mempel M, Schmidt T, Weidinger S et al. Role of Staphylococcus aureus surface-associated proteins in the attachment to cultured HaCaT keratinocytes in a new adhesion assay. J Invest Dermatol 1998;111(3):452–6.

14 Cho SH, Strickland I, Boguniewicz M, Leung DY. Fibronectin and fibrinogen contribute to the enhanced binding of Staphylococcus aureus to atopic skin. J Allergy Clin Immunol 2001;108(2):269–74.

15 Postlethwaite AE, Holness MA, Katai H, Raghow R. Human fibroblasts synthesize elevated levels of extracellular matrix proteins in response to interleukin 4. J Clin Invest 1992;90(4):1479–85.

16 Wann ER, Gurusiddappa S, Hook M. The fibronectin-binding MSCRAMM FnbpA of Staphylococcus aureus is a bifunctional protein that also binds to fibrinogen. J Biol Chem 2000;275(18):13863–71.

17 Palmer CN, Irvine AD, Terron-Kwiatkowski A et al. Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis. Nat Genet 2006;38(4):441–6.

18 Mempel M, Schnopp C, Hojka M et al. Invasion of human keratinocytes by Staphylococcus aureus and intracellular bacterial persistence represent haemolysin-independent virulence mechanisms that are followed by features of necrotic and apoptotic keratinocyte cell death. Br J Dermatol 2002;146(6):943–51.

19 Walev I, Martin E, Jonas D et al. Staphylococcal alpha-toxin kills human keratinocytes by permeabilizing the plasma membrane for monovalent ions. Infect Immun 1993;61(12):4972–9.

20 Leung DY, Gately M, Trumble A, Ferguson-Darnell B, Schlievert PM, Picker LJ. Bacterial superantigens induce T cell expression of the skin-selective homing receptor, the cutaneous lymphocyte-associated antigen, via stimulation of interleukin 12 production. J Exp Med 1995;181(2):747–53.

21 Leung DY, Harbeck R, Bina P et al. Presence of IgE antibodies to staphylococcal exotoxins on the skin of patients with atopic dermatitis. Evidence for a new group of allergens. J Clin Invest 1993;92(3):1374–80.

22 Bunikowski R, Mielke M, Skarabis H et al. Prevalence and role of serum IgE antibodies to the Staphylococcus aureus-derived superantigens SEA and SEB in children with atopic dermatitis. J Allergy Clin Immunol 1999;103(1 Pt 1):119–24.

23 Nomura I, Tanaka K, Tomita H et al. Evaluation of the staphylococcal exotoxins and their specific IgE in childhood atopic dermatitis. J Allergy Clin Immunol 1999;104(2 Pt 1):441–6.

24 Lin YT, Shau WY, Wang LF et al. Comparison of serum specific IgE antibodies to staphylococcal enterotoxins between atopic children with and without atopic dermatitis. Allergy 2000;55(7):641–6.

25 Strange P, Skov L, Lisby S, Nielsen PL, Baadsgaard O. Staphylococcal enterotoxin B applied on intact normal and intact atopic skin induces dermatitis. Arch Dermatol 1996;132(1):27–33.

26 Skov L, Olsen JV, Giorno R, Schlievert PM, Baadsgaard O, Leung DY. Application of Staphylococcal enterotoxin B on normal and atopic skin induces up-regulation of T cells by a superantigen-mediated mechanism. J Allergy Clin Immunol 2000;105(4):820–6.

27 Saloga J, Leung DY, Reardon C, Giorno RC, Born W, Gelfand EW. Cutaneous exposure to the superantigen staphylococcal enterotoxin B elicits a T-cell-dependent inflammatory response. J Invest Dermatol 1996;106(5):982–8.

28 Neuber K, Loliger C, Kohler I, Ring J. Preferential expression of T-cell receptor V beta-chains in atopic eczema. Acta Derm Venereol 1996;76(3):214–18.

29 Hofer MF, Harbeck RJ, Schlievert PM, Leung DY. Staphylococcal toxins augment specific IgE responses by atopic patients exposed to allergen. J Invest Dermatol 1999;112(2):171–6.

30 McFadden JP, Noble WC, Camp RD. Superantigenic exotoxin-secreting potential of staphylococci isolated from atopic eczematous skin. Br J Dermatol 1993;128(6):631–2.

31 Jappe U, Heuck D, Witte W, Gollnick H. Superantigen production by Staphylococcus aureus in atopic dermatitis: no more than a coincidence? J Invest Dermatol 1998;110(5):844–6.

32 Jarraud S, Peyrat MA, Lim A et al. egc, a highly prevalent operon of enterotoxin gene, forms a putative nursery of superantigens in Staphylococcus aureus. J Immunol 2001;166(1):669–77.

33 Novak N, Allam JP, Bieber T. Allergic hyperreactivity to microbial components: a trigger factor of “intrinsic” atopic dermatitis? J Allergy Clin Immunol 2003;112(1):215–16.

34 Reefer AJ, Satinover SM, Wilson BB, Woodfolk JA. The relevance of microbial allergens to the IgE antibody repertoire in atopic and nonatopic eczema. J Allergy Clin Immunol 2007;120(1):156–63.

35 Schnopp C, Grosch J, Ring J, Ollert M, Mempel M. Microbial allergen-specific IgE is not suitable to identify the intrinsic form of atopic eczema in children. J Allergy Clin Immunol 2008;121(1):267–8 e1; author reply 268.

36 Iwatsuki K, Yamasaki O, Morizane S, Oono T. Staphylococcal cutaneous infections: invasion, evasion and aggression. J Dermatol Sci 2006;42(3):203–14.

37 Curry JL, Qin JZ, Bonish B et al. Innate immune-related receptors in normal and psoriatic skin. Arch Pathol Lab Med 2003;127(2):178–86.

38 Kollisch G, Kalali BN, Voelcker V et al. Various members of the Toll-like receptor family contribute to the innate immune response of human epidermal keratinocytes. Immunology 2005;114(4):531–41.

39 Frohm M, Agerberth B, Ahangari G et al. The expression of the gene coding for the antibacterial peptide LL-37 is induced in human keratinocytes during inflammatory disorders. J Biol Chem 1997;272(24):15258–63.

40 Harder J, Siebert R, Zhang Y et al. Mapping of the gene encoding human beta-defensin-2 (DEFB2) to chromosome region 8p22-p23.1. Genomics 1997;46(3):472–5.

41 Harder J, Bartels J, Christophers E, Schroder JM. Isolation and characterization of human beta-defensin-3, a novel human inducible peptide antibiotic. J Biol Chem 2001;276(8):5707–13.

42 Stolzenberg ED, Anderson GM, Ackermann MR, Whitlock RH, Zasloff M. Epithelial antibiotic induced in states of disease. Proc Natl Acad Sci USA 1997;94(16):8686–90.

43 Hamid Q, Boguniewicz M, Leung DY. Differential in situ cytokine gene expression in acute versus chronic atopic dermatitis. J Clin Invest 1994;94(2):870–6.

44 Ong PY, Ohtake T, Brandt C et al. Endogenous antimicrobial peptides and skin infections in atopic dermatitis. N Engl J Med 2002;347(15):1151–60.

45 Nomura I, Goleva E, Howell MD et al. Cytokine milieu of atopic dermatitis, as compared to psoriasis, skin prevents induction of innate immune response genes. J Immunol 2003;171(6):3262–9.

46 Glaser R, Meyer-Hoffert U, Harder J et al. The antimicrobial protein psoriasin (S100A7) is upregulated in atopic dermatitis and after experimental skin barrier disruption. J Invest Dermatol 2009;129(3):641–9.

47 Stalder JF, Fleury M, Sourisse M, Rostin M, Pheline F, Litoux P. Local steroid therapy and bacterial skin flora in atopic dermatitis. Br J Dermatol 1994;131(4):536–40.

48 Pournaras CC, Lubbe J, Saurat JH. Staphylococcal colonization in atopic dermatitis treatment with topical tacrolimus (Fk506). J Invest Dermatol 2001;116(3):480–1.

49 Wohlrab J, Jost G, Abeck D. Antiseptic efficacy of a low-dosed topical triclosan/chlorhexidine combination therapy in atopic dermatitis. Skin Pharmacol Physiol 2007;20(2):71–6.

50 Gauger A, Mempel M, Schekatz A, Schafer T, Ring J, Abeck D. Silver-coated textiles reduce Staphylococcus aureus colonization in patients with atopic eczema. Dermatology 2003;207(1):15–21.

51 Brockow K, Grabenhorst P, Abeck D et al. Effect of gentian violet, corticosteroid and tar preparations in Staphylococcus-aureus-colonized atopic eczema. Dermatology 1999;199(3):231–6.

52 Mitra A, Mohanraj M, Shah M. High levels of fusidic acid-resistant Staphylococcus aureus despite restrictions on antibiotic use. Clin Exp Dermatol 2009;34(2):136–9.

Only gold members can continue reading. Log In or Register to continue

Apr 26, 2016 | Posted by in Dermatology | Comments Off on 26 Microbiology in Atopic Eczema
Premium Wordpress Themes by UFO Themes