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Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity.
Pediatrics. 2009 May; 123(5):e808-14.Ped

Abstract

OBJECTIVES

The goals were to determine the prevalence of community-acquired methicillin-resistant Staphylococcus aureus colonization in patients with atopic dermatitis and to determine whether suppression of S aureus growth with sodium hypochlorite (bleach) baths and intranasal mupirocin treatment improves eczema severity.

METHODS

A randomized, investigator-blinded, placebo-controlled study was conducted with 31 patients, 6 months to 17 years of age, with moderate to severe atopic dermatitis and clinical signs of secondary bacterial infections. All patients received orally administered cephalexin for 14 days and were assigned randomly to receive intranasal mupirocin ointment treatment and sodium hypochlorite (bleach) baths (treatment arm) or intranasal petrolatum ointment treatment and plain water baths (placebo arm) for 3 months. The primary outcome measure was the Eczema Area and Severity Index score.

RESULTS

The prevalence of community-acquired methicillin-resistant S aureus in our study (7.4% of our S aureus-positive skin cultures and 4% of our S aureus-positive nasal cultures) was much lower than that in the general population with cultures at Children's Memorial Hospital (75%-85%). Patients in the group that received both the dilute bleach baths and intranasal mupirocin treatment showed significantly greater mean reductions from baseline in Eczema Area and Severity Index scores, compared with the placebo group, at the 1-month and 3-month visits. The mean Eczema Area and Severity Index scores for the head and neck did not decrease for patients in the treatment group, whereas scores for other body sites (submerged in the dilute bleach baths) decreased at 1 and 3 months, in comparison with placebo-treated patients.

CONCLUSIONS

Chronic use of dilute bleach baths with intermittent intranasal application of mupirocin ointment decreased the clinical severity of atopic dermatitis in patients with clinical signs of secondary bacterial infections. Patients with atopic dermatitis do not seem to have increased susceptibility to infection or colonization with resistant strains of S aureus.

Authors+Show Affiliations

Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19403473

Citation

Huang, Jennifer T., et al. "Treatment of Staphylococcus Aureus Colonization in Atopic Dermatitis Decreases Disease Severity." Pediatrics, vol. 123, no. 5, 2009, pp. e808-14.
Huang JT, Abrams M, Tlougan B, et al. Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity. Pediatrics. 2009;123(5):e808-14.
Huang, J. T., Abrams, M., Tlougan, B., Rademaker, A., & Paller, A. S. (2009). Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity. Pediatrics, 123(5), e808-14. https://doi.org/10.1542/peds.2008-2217
Huang JT, et al. Treatment of Staphylococcus Aureus Colonization in Atopic Dermatitis Decreases Disease Severity. Pediatrics. 2009;123(5):e808-14. PubMed PMID: 19403473.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity. AU - Huang,Jennifer T, AU - Abrams,Melissa, AU - Tlougan,Brook, AU - Rademaker,Alfred, AU - Paller,Amy S, PY - 2009/5/1/entrez PY - 2009/5/1/pubmed PY - 2009/5/27/medline SP - e808 EP - 14 JF - Pediatrics JO - Pediatrics VL - 123 IS - 5 N2 - OBJECTIVES: The goals were to determine the prevalence of community-acquired methicillin-resistant Staphylococcus aureus colonization in patients with atopic dermatitis and to determine whether suppression of S aureus growth with sodium hypochlorite (bleach) baths and intranasal mupirocin treatment improves eczema severity. METHODS: A randomized, investigator-blinded, placebo-controlled study was conducted with 31 patients, 6 months to 17 years of age, with moderate to severe atopic dermatitis and clinical signs of secondary bacterial infections. All patients received orally administered cephalexin for 14 days and were assigned randomly to receive intranasal mupirocin ointment treatment and sodium hypochlorite (bleach) baths (treatment arm) or intranasal petrolatum ointment treatment and plain water baths (placebo arm) for 3 months. The primary outcome measure was the Eczema Area and Severity Index score. RESULTS: The prevalence of community-acquired methicillin-resistant S aureus in our study (7.4% of our S aureus-positive skin cultures and 4% of our S aureus-positive nasal cultures) was much lower than that in the general population with cultures at Children's Memorial Hospital (75%-85%). Patients in the group that received both the dilute bleach baths and intranasal mupirocin treatment showed significantly greater mean reductions from baseline in Eczema Area and Severity Index scores, compared with the placebo group, at the 1-month and 3-month visits. The mean Eczema Area and Severity Index scores for the head and neck did not decrease for patients in the treatment group, whereas scores for other body sites (submerged in the dilute bleach baths) decreased at 1 and 3 months, in comparison with placebo-treated patients. CONCLUSIONS: Chronic use of dilute bleach baths with intermittent intranasal application of mupirocin ointment decreased the clinical severity of atopic dermatitis in patients with clinical signs of secondary bacterial infections. Patients with atopic dermatitis do not seem to have increased susceptibility to infection or colonization with resistant strains of S aureus. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/19403473/Treatment_of_Staphylococcus_aureus_colonization_in_atopic_dermatitis_decreases_disease_severity_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=19403473 DB - PRIME DP - Unbound Medicine ER -