Treatment of <i>Staphylococcus aureus</i> Colonization in Atopic Dermatitis Decreases Disease Severity

Huang, Jennifer T.; Abrams, Melissa; Tlougan, Brook E.; Rademaker, Alfred; Paller, Amy S.

doi:10.1542/peds.2008-2217

Cited by 455 publications

(363 citation statements)

References 35 publications

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“…Those in the treatment group had significant improvement in their AD severity scores versus those in the placebo group. 56 Areas of the body that were not submerged in the bleach-containing water, specifically the head and the neck, revealed no difference in AD severity scores between the 2 groups. The treatment was well tolerated, without any adverse effect, and without any increase in resistant strains of S aureus.…”

Section: Managing Infectious Triggersmentioning

confidence: 89%

“…56 Pruritus may occur even in patients who are colonized but not actively infected. Many patients with AD have sudden exacerbations of their disease that can be attributed to active infection with bacteria, most commonly S aureus, and active treatment of the infection subsequently improves the skin.…”

Section: Managing Infectious Triggersmentioning

confidence: 99%

“…Many patients with AD have sudden exacerbations of their disease that can be attributed to active infection with bacteria, most commonly S aureus, and active treatment of the infection subsequently improves the skin. 56 Clinical signs of infection, such as pustules, oozing and honey-colored crusts, and less commonly fever and cellulitis, may lead the primary care provider to prescribe antibacterial treatment. Secondary infection of AD is a clinical diagnosis and is often associated with flare of the underlying AD.…”

Section: Managing Infectious Triggersmentioning

confidence: 99%

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Atopic Dermatitis: Skin-Directed Management

Tollefson¹,

Bruckner²,

Dermatology³

2014

Pediatrics

111

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Atopic dermatitis is a common inflammatory skin condition characterized by relapsing eczematous lesions in a typical distribution. It can be frustrating for pediatric patients, parents, and health care providers alike. The pediatrician will treat the majority of children with atopic dermatitis as many patients will not have access to a pediatric medical subspecialist, such as a pediatric dermatologist or pediatric allergist. This report provides up-to-date information regarding the disease and its impact, pathogenesis, treatment options, and potential complications. The goal of this report is to assist pediatricians with accurate and useful information that will improve the care of patients with atopic dermatitis. Pediatrics 2014;134:e1735-e1744Atopic dermatitis (AD), commonly referred to as eczema, is a chronic, relapsing, and often intensely pruritic inflammatory disorder of the skin. A recent epidemiologic study using national data suggested that the pediatric prevalence is at least 10% in most of the United States. 1 AD primarily affects children, and disease onset occurs before the ages of 1 and 5 years in 65% and 85% of affected children, respectively. 1 The number of office visits for children with AD is increasing. 2 Up to 80% of children with AD are diagnosed and managed by primary care providers, often pediatricians. 3 Although medical subspecialists, such as pediatric dermatologists and/or pediatric allergists, may be suited to provide more advanced care for children with AD, lack of a sufficient number of such physicians, particularly pediatric dermatologists, 4 likely means the burden of AD care will continue to fall to primary care providers. Although consensus guidelines and practice parameters regarding the management of AD in children have been published, 5-10 considerable variability persists in clinical practice, particularly regarding the roles that bathing, moisturizing, topical medications, and allergies play in management. Inconsistencies in opinion and treatment approach as well as the chronic and relapsing nature of AD can lead to frustration for the patient, family, and primary care providers when managing AD. STATEMENT OF THE PROBLEMNew data support the theory that AD results from primary abnormalities of the skin barrier, 11 suggesting that skin-directed management of AD is of paramount importance. This clinical report reviews AD and provides an up-to-date approach to skin-directed management that is based on pathogenesis. Effectively using this information to create treatment plans

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Section: Managing Infectious Triggersmentioning

confidence: 89%

Section: Managing Infectious Triggersmentioning

confidence: 99%

Section: Managing Infectious Triggersmentioning

confidence: 99%

See 1 more Smart Citation

Atopic Dermatitis: Skin-Directed Management

Tollefson¹,

Bruckner²,

Dermatology³

2014

Pediatrics

111

View full text Add to dashboard Cite

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“…3,[9][10][11] It has also been noted that the elimination of the bacteria can relieve the symptoms in AD patients. 4,5 However, the pathological mechanism underlying S. aureus-exacerbated AD remains to be addressed, and no publications have elucidated the cellular and molecular pathways by which epicutaneous S. aureus infection leads to the deterioration of AD. Therefore, the current study focused on the in vivo and in vitro effects of the S. aureus-associated NOD2/TLR2 ligands and revealed that NOD2 and TLR2 exacerbated AD-like skin inflammation and induced the activation of basophils and eosinophils by interacting with dermal fibroblasts.…”

Section: Discussionmentioning

confidence: 99%

“…3 Therapeutic interventions to eliminate S. aureus have been shown to alleviate AD symptoms, suggesting a deteriorating role for S. aureus in the disease. 4,5 Percutaneous application of peptidoglycan (PGN), which is a cell wall component of S. aureus, induces eosinophil infiltration in the skin. 6 Lipoteichoic acid (LTA), another cell wall component of S. aureus, is widely present in AD skin lesions, and its amount detected in the skin correlate with the severity of AD.…”

Section: Introductionmentioning

confidence: 99%

NOD2 and TLR2 ligands trigger the activation of basophils and eosinophils by interacting with dermal fibroblasts in atopic dermatitis-like skin inflammation

et al. 2015

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The skin of patients with atopic dermatitis (AD) has a unique predisposition for colonization by Staphylococcus aureus (S. aureus), which contributes to the inflammation and grim prognosis of AD. Although the mechanism underlying the S. aureus-induced exacerbation of AD remains unclear, recent studies have found a pivotal role for pattern recognition receptors in regulating the inflammatory responses in S. aureus infection. In the present study, we used a typical mouse model of AD-like skin inflammation and found that S. aureus-associated nucleotide-binding oligomerization domain-containing protein 2 (NOD2) and toll-like receptor 2 (TLR2) ligands exacerbated AD-like symptoms, which were further deteriorated by the in vivo expansion of basophils and eosinophils. Subsequent histological analyses revealed that dermal fibroblasts were pervasive in the AD-like skin lesions. Co-culture of human dermal fibroblasts with basophils and eosinophils resulted in a vigorous cytokine/chemokine response to the NOD2/TLR2 ligands and the enhanced expression of intercellular adhesion molecule-1 on the dermal fibroblasts. Basophils and eosinophils were primarily responsible for the AD-related cytokine/chemokine expression in the co-cultures. Direct intercellular contact was necessary for the crosstalk between basophils and dermal fibroblasts, while soluble mediators were sufficient to mediate the eosinophil-fibroblast interactions. Moreover, the intracellular p38 mitogen-activated protein kinase, extracellular signal-regulated kinase, and nuclear factor-kappa B signaling pathways were essential for NOD2/TLR2 ligand-mediated activation of basophils, eosinophils, and dermal fibroblasts in AD-related inflammation. This study provides the evidence of NOD2/TLR2-mediated exacerbation of AD through activation of innate immune cells and therefore sheds light on a novel mechanistic pathway by which S. aureus contributes to the pathophysiology of AD. Cellular & Molecular Immunology

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