The infectious complications of atopic dermatitis

Abstract

Objective Atopic dermatitis (AD) is a chronic inflammatory skin disease that is complicated by an increased risk for skin and systemic infections. Preventive therapy for AD is based on skin barrier improvement and anti-inflammatory treatments, whereas overt skin and systemic infections require antibiotics or antiviral treatments. This review updates the pathophysiology, diagnosis, management, controversy of antibiotic use, and potential treatments of infectious complications of AD. Data Sources Published literature obtained through PubMed database searches and clinical pictures. Study Selections Studies relevant to the mechanisms, diagnosis, management, and potential therapy of infectious complications of AD. Results Skin barrier defects, type 2 inflammation, Staphylococcus aureus colonization, and cutaneous dysbiosis are the major predisposing factors for the increased infections in AD. Although overt infections require antibiotics, the use of antibiotics in AD exacerbation remains controversial. Conclusion Infectious complications are a comorbidity of AD. Although not common, systemic bacterial infections and eczema herpeticum can be life-threatening. Preventive therapy of infections in AD emphasizes skin barrier improvement and anti-inflammatory therapy. The use of antibiotics in AD exacerbation requires further studies.

Determination of nasal carriage and skin colonization, antimicrobial susceptibility and genetic relatedness of Staphylococcus aureus isolated from patients with atopic dermatitis in Szczecin, Poland

“…It has been demonstrated that the progression and severity of AD are closely related with the ability of S. aureus to penetrate through skin barrier what stimulates the immune response leading to the persistent skin inflammation [ 22 ]. Dehydrated and thinner skin of AD patients is much more vulnerable to injury and therefore to infection and irritation by allergens [ 26 ]. Celakovska and Bukac [ 27 , 28 ] observed the significant relation between the severity of AD and sensitization mites, animal dander, dust of feather.…”

Atopic dermatitis in children: when topical steroid treatment “does not work”

“…Cutaneous Staphylococcus aureus colonisation may trigger frequent flares and super-infections of eczematous lesions, as enterotoxins and scratching break down the skin barrier 325. The presence of fever, pain, pus, discharge, or crusts is consistent with bacterial infection.…”

“…The presence of fever, pain, pus, discharge, or crusts is consistent with bacterial infection. Obtain swab cultures from lesions that appear infected, nares, or skin folds to identify the bacteria and treat according to culture results 25. Children with recurrent skin infections may benefit from a bleach bath 26…”

“…Consider eczema herpeticum (herpes virus infection) in patients with painful vesicles and punched out erosions with dermatitis 1225. Eczema herpeticum requires urgent referral and acyclovir treatment as it can lead to meningoencephalitis and fatality 101225.…”

“…Consider eczema herpeticum (herpes virus infection) in patients with painful vesicles and punched out erosions with dermatitis 1225. Eczema herpeticum requires urgent referral and acyclovir treatment as it can lead to meningoencephalitis and fatality 101225. Seborrhoeic dermatitis (malassezia yeast infection) presents with a head-neck distribution of pink patches with greasy white or yellow scales and is treated with antifungal agents 27…”