title: Hydrocortisone acetate alone or combined with mupirocin for atopic dermatitis in infants under two years of age - a randomized double blind pilot trial.
abstract: BACKGROUND
  The skin of patients with atopic dermatitis (AD) is heavily colonized with Staphylococcus (S.) aureus, even at uninvolved sites. Toxins secreted by the majority of S. aureus on the skin behave as superantigens and can directly influence the disease activity, although clinical signs of bacterial superinfection might be absent.
  
  
  OBJECTIVE
  This study was conducted to compare the efficacy of hydrocortisone cream, combined with mupirocin or alone with emmolient ointment for the treatment of mild to moderate AD in infants between six months and two years of age.
  
  
  METHODS
  A total of 83 patients with mild to moderate AD were randomized to receive hydrocortisone, hydrocortisone+ mupirocin or emmolient ointment twice daily in one week and followed-up for 8 weeks, in a blind study. Efficacy evaluation made by SCORAD and eczema area and severity index (EASI) at baseline, day 7, and weeks 2, 4, and 8. Possible adverse events were recorded to evaluate safety.
  
  
  RESULTS
  At the end of study, 65% (17 of 26) of the patients were treated successfully with hydrocortisone ointment based on SCORAD and EASI scores. Also there was a significant improvement in patients combined with mupirocin ointment [74% (20 of 27)]. The percent improvement from baseline in EASI scores was also significantly greater in hydrocortisone and combined group compared with emmolient-treated patients (36%) (p = 0.0187, p = 0.012 respectively).
  
  
  CONCLUSIONS
  Monotherapy with hydrocortisone ointment is the main treatment in infants with mild to moderate AD and combination with mupirocin is safe and effective often needed because of possible Staphylococcus carriage.
authors.affiliation: Clinic of Dermatology, Ministry of Health, Yildirim Beyazit Education and Research Hospital, Ankara, Turkey. filizcanpolat@hotmail.com
authors.forename: F
authors.initials: F
authors.lastname: Canpolat
authors.forename: M
authors.initials: M
authors.lastname: Erkoçoğlu
authors.forename: H
authors.initials: H
authors.lastname: Tezer
authors.forename: C N
authors.initials: CN
authors.lastname: Kocabaş
authors.forename: B
authors.initials: B
authors.lastname: Kandi
mesh_terms: D000279:Administration, Cutaneous; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003876:Dermatitis, Atopic / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004643:Emollients / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D007223:Infant; D016712:Mupirocin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009824:Ointments; D010865:Pilot Projects; D012720:Severity of Illness Index; D012867:Skin / Q000187:drug effects* / Q000382:microbiology / Q000473:pathology; D013207:Staphylococcal Skin Infections / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D004643:Emollients; D009824:Ointments; C021650:hydrocortisone acetate; D016712:Mupirocin; D006854:Hydrocortisone