title: The role of extracellular polysaccharide substance produced by Staphylococcus epidermidis in miliaria.
abstract: BACKGROUND
  Previous studies have indicated that cutaneous bacteria, particularly coagulase-negative staphylococci, play a role in the pathogenesis of miliaria. An accumulation of periodic acid-Schiff (PAS)-positive material has been described as blocking the sweat duct in miliaria. Furthermore, a PAS-positive extracellular polysaccharide substance (EPS) has been identified as a product of some strains of Staphylococcus epidermidis.
  
  
  OBJECTIVE
  We evaluated the relative ability of various species of coagulase-negative staphylococci to induce miliaria with particular reference to the potential role of EPS.
  
  
  METHODS
  We inoculated various strains of coagulase-negative staphylococci on the volar forearms of subjects under an occlusive dressing coupled with thermal stimulation. Ability to induce miliaria as well as microbiologic, histologic, and immunostaining features were evaluated.
  
  
  RESULTS
  Miliaria was induced only with strains of S. epidermidis; other species including S. haemolyticus, S. hominis, S. cohnii, S. saprophyticus, and S. simulans were not capable of inducing miliaria. Moreover, only S. epidermidis strains capable of producing EPS were capable of inducing miliaria.
  
  
  CONCLUSIONS
  Our data indicate that EPS is the PAS-positive material that obstructs the delivery of sweat to the skin surface in miliaria and therefore demonstrate that the EPS produced by S. epidermidis plays a central role in the pathogenesis of miliaria. Furthermore, in a survey of staphylococcal flora isolated from 68 subjects, EPS-producing strains were found to be common.
authors.affiliation: Department of Dermatology, University of Pennsylvania, Philadelphia, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Mowad
authors.forename: K J
authors.initials: KJ
authors.lastname: McGinley
authors.forename: A
authors.initials: A
authors.lastname: Foglia
authors.forename: J J
authors.initials: JJ
authors.lastname: Leyden
mesh_terms: D000293:Adolescent; D000328:Adult; D015169:Colony Count, Microbial; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D008883:Miliaria / Q000382:microbiology* / Q000473:pathology / Q000503:physiopathology; D010503:Periodic Acid-Schiff Reaction; D011135:Polysaccharides, Bacterial / Q000378:metabolism*; D012867:Skin / Q000382:microbiology / Q000473:pathology; D013210:Staphylococcus / Q000302:isolation & purification; D013212:Staphylococcus epidermidis / Q000302:isolation & purification / Q000378:metabolism*
chemical_list: D011135:Polysaccharides, Bacterial