title: Combined antibiotic/corticosteroid cream in the empirical treatment of moderate to severe eczema: friend or foe?
abstract: BACKGROUND
  Eczema is a common atopic disease associated with pruritus, sleep disturbance, and impaired quality of life. Staphylococcus aureus colonization/infection is important in its pathophysiology.
  
  
  OBJECTIVE
  To evaluate the prevalence of S aureus colonization/infection and the efficacy and acceptability of a combined antibiotic/corticosteroid cream in the empirical treatment of eczema.
  
  
  METHODS
  Consecutive patients with moderate to severe eczema were recruited. Swab and cultures from the right antecubital fossa and the worst eczematous area, disease severity (SCORAD) and quality of life (Children's Dermatology Life Quality Index, CDLQI), skin hydration (SH), and transepidermal water loss (TEWL) were obtained prior to and following a two week twice-daily course of treatment with a fucidin/corticosteroid cream. General acceptability of treatment (GAT) was documented at completion.
  
  
  RESULTS
  Thirty-five patients (63% males; mean age 13.5, standard deviation 3.6 years; with 21 moderate and 14 severe disease) were recruited. At start, S aureus was isolated from the right antecubital fossa and the worst affected areas in 66% and 71% of these patients, respectively. At completion, S aureus was isolated in 23% and 40% at the antecubital fossae and worst affected areas (P=0.001 and P=0.003, respectively). No methicillin-resistant S aureus was isolated in this series, but the percentage of fucidin-resistant S aureus increased from 8% to 58% (P<0.001). Disease severity and quality of life were significantly improved (pre-Objective SCORAD and post-Objective SCORAD were 38.4±13.7 and 29.7±14.2, P<0.001; pre-CDLQI and post-CDLQI were 9.4±5.2 and 7.1±4.8, P<0.001). At the right antecubital fossa, skin hydration improved from 30.8±14.2 to 36.7±15.2 (P=0.015); and TEWL from 10.7±2.3 to 9.4±2.2 (P<0.001). Eighty percent of patients found the treatment good or very good, and only one (3%) patient found it unacceptable.
  
  
  CONCLUSIONS
  The most prevalent organism in moderate to severe eczema was S aureus. Usage of the combined fucidin/corticosteroid cream is convenient and associated with a reduction in disease severity, improvement in quality of life, SH, and TEWL, but caution has to be taken with emergence of fucidin-resistant S aureus.
authors: Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China. ehon@cuhk.edu.hk
authors: Kam Lun
authors: KL
authors: Hon
authors: Shuxin Susan
authors: SS
authors: Wang
authors: Kenneth K C
authors: KK
authors: Lee
authors: Vivian W Y
authors: VW
authors: Lee
authors: Ting Fan
authors: TF
authors: Leung
authors: Margaret
authors: M
authors: Ip
mesh_terms: D000279:Administration, Cutaneous; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001623:Betamethasone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D004338:Drug Combinations; D024881:Drug Resistance, Bacterial; D004485:Eczema / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D005260:Female; D005672:Fusidic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011788:Quality of Life; D012720:Severity of Illness Index; D013207:Staphylococcal Skin Infections / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004338:Drug Combinations; C524642:Fucicort; D005938:Glucocorticoids; D005672:Fusidic Acid; D001623:Betamethasone