<b><i>Background:</i></b> Atopic dermatitis is a chronic inflammatory dermatosis with complex pathogenesis. The skin microbiome in atopic dermatitis is dominated by <i>Staphylococcus aureus</i> which shows the ability to produce biofilm. <b><i>Objectives:</i></b> The aim of this work was to assess the influence of <i>S. aureus</i> biofilm on the course of atopic dermatitis. <b><i>Methods:</i></b> Disease severity was evaluated based on the SCORAD index in 56 adult patients with atopic dermatitis. Microtiter plate assay of the propensity to form biofilm was performed on <i>S. aureus</i> strains isolated from the anterior nares, lesional skin, and nonlesional skin. Microbiological results were correlated to the clinical parameters and total IgE concentration. <b><i>Results:</i></b> Biofilm-producing strains of <i>S. aureus</i> were identified in 76.3% (29/38) and 79.1% (34/43) of samples from the anterior nares and lesional skin, respectively (<i>p</i> > 0.05), and in 48.5% (16/33) of samples from nonlesional skin (<i>p</i> < 0.03). Patients colonized by biofilm-producing strains of <i>S. aureus</i> within the anterior nares showed statistically higher mean values of total and objective SCORAD and its components (extent, dryness), and of the largest extent of skin lesions during the flares in the last year when compared to patients colonized by non-biofilm-producing strains. Carriage of biofilm-producing <i>S. aureus</i> on lesional skin was associated with higher mean values of the extent of skin lesions during stable periods of the disease. <b><i>Conclusions:</i></b> The results of this study may suggest a relationship between the production of biofilm by <i>S. aureus</i> strains colonizing the anterior nares and the course of atopic dermatitis. Biofilm seems crucial for dispersal and persistent colonization of large areas of the skin by this pathogen. Destruction of <i>S. aureus</i> biofilm could positively affect the course of atopic dermatitis.
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