Clinical Signs, Staphylococcus and Atopic Eczema-Related Seromarkers

Abstract

Childhood eczema or atopic dermatitis (AD) is a distressing disease associated with pruritus, sleep disturbance, impaired quality of life and Staphylococcus aureus isolation. The pathophysiology of AD is complex and various seromarkers of immunity are involved. We investigated if anti-staphylococcal enterotoxin IgE (anti-SE), selected seromarkers of T regulatory (Treg), T helper (Th) and antigen-presenting cells (APC) are associated with clinical signs of disease severity and quality of life. Disease severity was assessed with the Scoring Atopic Dermatitis (SCORAD) index, and quality of life with the Children’s Dermatology Life Quality Index (CDLQI) in AD patients ≤18 years old. Concentrations of anti-staphylococcus enterotoxin A and B immunoglobulin E (anti-SEA and anti-SEB), selected Treg/Th/APC chemokines, skin hydration and transepidermal water loss (TEWL) were measured in these patients. Forty patients with AD [median (interquartile range) age of 13.1 (7.9) years) were recruited. Backward stepwise linear regression (controlling for age, personal allergic rhinitis and asthma, and other blood markers) showed the serum anti-SEB level was positively associated with S. aureus and S. epidermidis isolations, objective SCORAD, clinical signs and CDLQI. TNF-α (a Th1 cytokine) was positively associated with objective SCORAD (B = 4.935, p = 0.010), TGF-β (a Treg cytokine) negatively with disease extent (B = −0.015, p = 0.001), IL-18 (an APC cytokine) positively with disease extent (B = 0.438, p = 0.001) and with TEWL (B = 0.040, p = 0.010), and IL-23 (an APC cytokine) negatively with disease extent (B = −2.812, p = 0.006) and positively with pruritus (B = 0.387, p = 0.007). Conclusions: Blood levels of anti-SEB, Th1, Treg and APC cytokines are correlated with various clinical signs of AD. AD is a systemic immunologic disease involving Staphylococcus aureus, cellular, humoral, cytokine and chemokine pathophysiology.

Practical Recommendations for the Topical Treatment of Atopic Dermatitis in South and East Asia

“…The interplay of skin barrier defects, immune abnormalities, the microbiome, and environmental triggers appears to promote inflammatory responses involving T cells, chemokines, and cytokines. These inflammatory responses lead to the characteristic pruritic flares of AD [1,[32][33][34][35]. Topical anti-inflammatory treatments are therefore an integral part of the management of AD and include two predominant classes: TCS (numerous different agents with a range of potencies) and TCI (tacrolimus and pimecrolimus).…”

A Phytocomplex Consisting of Tropaeolum majus L. and Salvia officinalis L. Extracts Alleviates the Inflammatory Response of Dermal Fibroblasts to Bacterial Lipopolysaccharides

“…It had been shown that the colonization of skin lesions with Staphylococcus aureus or other bacterial, fungal, and viral agents reduced the commensal flora and aggravated the flares of the disease. It was demonstrated that Staphylococcus aureus produced the virulence factors such as biofilm, superantigens, αtoxin, and protein A which reduce the effectiveness of antibiotic treatment [47] and stimulate the immune system and are positively correlated with disease severity [48].…”

Dismissing the fallacies of childhood eczema management: case scenarios and an overview of best practices

“… 38 It is established that AD is associated with S. aureus skin colonization and infection. 39 Diluted sodium hypochlorite bath has been shown to reduce bacterial load of skin lesions and disease severity in patients with AD. 40 – 42 …”