Risks forStaphylococcus aureuscolonization in patients with psoriasis: a systematic review and meta-analysis

Abstract

Evidence on whether patients with psoriasis have a higher risk for staphylococcal colonization than healthy controls remains controversial. To synthesize the current literature, we performed a systematic review on the prevalence and relative risk (RR) of Staphylococcus aureus colonization in patients with psoriasis. We modified the QUADAS-2 instrument to assess the reporting quality of individual studies and applied random-effects models in meta-analysis. Overall we identified 21 eligible studies, of which 15 enrolled one or more comparison groups. The pooled prevalence of staphylococcal colonization in patients with psoriasis was 35·3% [95% confidence interval (CI) 25·0-45·6] on lesional skin and 39·2% (95% CI 33·7-44·8) in the nares. Patients with psoriasis were 4·5 times more likely to be colonized by S. aureus than healthy controls were on the skin (RR 5·54, 95% CI 3·21-9·57) and 60% more in the nares (RR 1·60, 95% CI 1·11-2·32). Cutaneous and nasal colonization by meticillin-resistant S. aureus also appeared higher in patients with psoriasis (pooled prevalence 8·6%) than in healthy controls (2·6%), yet the difference was not statistically significant (P = 0·74). In contrast, despite of a similar risk for nasal staphylococcal colonization (RR 0·67, 95% CI 0·38-1·18), patients with psoriasis were less likely to carry S. aureus on lesional skin than atopic patients (RR 0·64, 95% CI 0·40-1·02). In summarizing the current literature, we found that patients with psoriasis were at an increased risk for staphylococcal colonization compared with healthy individuals. Prospective studies on how bacterial loads correlate with disease activity can guide the clinical management of bacterial colonization while preventing the emergence of drug-resistant strains.

Staphylococcus aureus Epicutaneous Exposure Drives Skin Inflammation via IL-36-Mediated T Cell Responses

“…The role of IL-36 could also be relevant beyond AD. For example, increased S. aureus colonization is found in lesional skin of individuals with psoriasis (Ng et al, 2017), a disease in which IL-36 contributes to IL-17 responses (Tortola et al, 2012). Finally, IL-36 could have similar activity as IL-1α in inducing IL-17 T cell responses during homeostasis, as was previously reported to occur after exposure of germ-free mice to epicutaneous S. epidermidis (Naik et al, 2012).…”

Initial Evidence of Distinguishable Bacterial and Fungal Dysbiosis in the Skin of Patients with Atopic Dermatitis or Netherton Syndrome

“…Thus, these results emphasize that atopic manifestations are probably not linked to the expansion of Staphylococcus aureus and vice versa. This hypothesis is further proven by recent work showing increased Staphylococcus aureus in psoriasis when compared to healthy controls (Chang HW et al, 2018;Ng CY et al, 2017), although to a lesser extent than in severe AD (Fyhrquist N et al, 2019). Moreover, antistaphylococcal treatments efficiently eliminate Staphylococcus aureus on the skin of AD patients but do not significantly improve disease when compared with nonantimicrobial agents (Bath-Hextall FJ et al, 2010), suggesting that Staphylococcus aureus might be a marker of disease severity rather than a major pathogenic factor.…”

RASSF1A Regulates the Abnormal Cell Proliferation in Psoriasis via Inhibition of YAP

“…Psoriasis affects all ages and genders equally 1,2 . Due to the high incidence, treatment resistance, recurrence, and often visible skin lesions, psoriasis causes psychological and social distress, which affect quality of life; it is, therefore, a persistent skin disease that affects human physical and mental healt h3,4 .…”