title: Treatment outcomes of secondarily impetiginized pediatric atopic dermatitis lesions and the role of oral antibiotics.
abstract: Patients with atopic dermatitis (AD) are predisposed to infection with Staphylococcus aureus, which worsens their skin disease; it has been postulated that the lack of antimicrobial peptides due to aberrant allergic inflammation in skin with AD could mediate this enhanced bacterial susceptibility. We sought to characterize the amounts of S. aureus and biological products found in infected AD lesions and whether treatment with topical corticosteroids and oral cephalexin as the only antimicrobial improved outcomes. Fifty-nine children with clinically and S. aureus-positive impetiginized lesions of AD were enrolled in this study. A lesion was graded clinically using the Eczema Area and Severity Index, and wash fluid was obtained from the lesion for quantitative bacterial culture and antibiotic sensitivities and measurement of bacterial products and cytokines. Subjects were re-evaluated 2 weeks after treatment. Improvement in the clinical and inflammatory characteristics of impetiginized lesions were noted, even in the 15% of lesions infected with Methicillin-resistant S. aureus (MRSA). In a subgroup of subjects whose lesions did not contain S. aureus 2 weeks after initiating treatment, beta-defensin levels were higher at both visits than in normal skin. Treatment of uncomplicated impetiginized pediatric AD with topical corticosteroids and cephalexin results in significant clinical improvement, even in subjects infected with MRSA. We propose that the inhibition of abnormal inflammation by the treatment regimen, resulting in the high levels of defensins, is involved in the improvement of AD and that systemic antibiotics do not appear to be necessary in secondary impetiginized AD.
authors.affiliation: Department of Dermatology, Indiana University School of Medicine, 550 N. University Blvd., suite 3240, Indianapolis, IN 46202, Indiana, USA. jtravers@iupui.edu
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Travers
authors.forename: Amal
authors.initials: A
authors.lastname: Kozman
authors.forename: Yongxue
authors.initials: Y
authors.lastname: Yao
authors.forename: Wenyu
authors.initials: W
authors.lastname: Ming
authors.forename: Weiguo
authors.initials: W
authors.lastname: Yao
authors.forename: Mathew J
authors.initials: MJ
authors.lastname: Turner
authors.forename: Mark H
authors.initials: MH
authors.lastname: Kaplan
authors.forename: Nico
authors.initials: N
authors.lastname: Mousdicas
authors.forename: Anita N
authors.initials: AN
authors.lastname: Haggstrom
authors.forename: Chandan
authors.initials: C
authors.lastname: Saha
mesh_terms: D000279:Administration, Cutaneous; D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D003879:Dermatologic Agents / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D012720:Severity of Illness Index; D013207:Staphylococcal Skin Infections / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D003879:Dermatologic Agents