title: Countering Staphylococcus Overgrowth During Patch Testing in Children with Moderate to Severe Atopic Dermatitis.
abstract: BACKGROUND
  Patients with moderate to severe atopic dermatitis (AD) often have a concurrent diagnosis of contact dermatitis, but patch testing in these patients presents a unique set of challenges. Barrier impairment and Staphylococcus aureus colonization and infection, along with the sealed occlusion that takes place during the patch testing procedure, can create an optimal environment for bacterial overgrowth.
  
  
  OBJECTIVE
  To identify patients at risk for S. aureus overgrowth during patch testing and provide pre- and peripatch testing interventions to aid clinicians in obtaining the best possible patch test results in this complicated population.
  
  
  METHODS
  A retrospective review was performed of five patients with moderate to severe AD for which S. aureus overgrowth and superinfection complicated patch test evaluation.
  
  
  RESULTS
  All five patients were able to complete the patch test procedure and all had relevant positive patch test reactions. Complications during patch testing included erythema, oozing, foul odor under the patches, and purulent material at the patch sites. One patient had a culture performed during patch testing that showed methicillin-sensitive S. aureus.
  
  
  CONCLUSIONS
  Patch testing can play an important role in the examination and management of patients with refractory AD.
  
  
  CONCLUSIONS
  Moderate to severe AD and concern regarding S. aureus overgrowth should not preclude patch testing.
authors.affiliation: Department of Dermatology, University of California at San Diego, San Diego, California.
authors.forename: Shehla
authors.initials: S
authors.lastname: Admani
authors.affiliation: Department of Dermatology, Rady Children's Hospital San Diego, University of California, San Diego, San Diego, California.
authors.forename: Catalina
authors.initials: C
authors.lastname: Matiz
authors.affiliation: Department of Dermatology, Loma Linda University, Loma Linda, California.|Contact Dermatitis Clinic, Loma Linda University, Loma Linda, California.
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Jacob
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D003876:Dermatitis, Atopic / Q000382:microbiology*; D003877:Dermatitis, Contact / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D010328:Patch Tests / Q000009:adverse effects*; D015995:Prevalence; D012189:Retrospective Studies; D013207:Staphylococcal Skin Infections / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents