Treatment outcomes of secondarily impetiginized pediatric atopic dermatitis lesions and the role of oral antibiotics

Jeffrey Travers, Amal Kozman, Yongxue Yao, Wenyu Ming, Weiguo Yao, Mathew J. Turner, Mark Kaplan, Nico Mousdicas, Anita Haggstrom, Chandan Saha

Research output: Contribution to journalArticle

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Abstract

Patients with atopic dermatitis (AD) are predisposed to infection with Staphylococcus aureus, which worsens their skin disease; it has been postulated that the lack of antimicrobial peptides due to aberrant allergic inflammation in skin with AD could mediate this enhanced bacterial susceptibility. We sought to characterize the amounts of S. aureus and biological products found in infected AD lesions and whether treatment with topical corticosteroids and oral cephalexin as the only antimicrobial improved outcomes. Fifty-nine children with clinically and S. aureus-positive impetiginized lesions of AD were enrolled in this study. A lesion was graded clinically using the Eczema Area and Severity Index, and wash fluid was obtained from the lesion for quantitative bacterial culture and antibiotic sensitivities and measurement of bacterial products and cytokines. Subjects were re-evaluated 2 weeks after treatment. Improvement in the clinical and inflammatory characteristics of impetiginized lesions were noted, even in the 15% of lesions infected with Methicillin-resistant S. aureus (MRSA). In a subgroup of subjects whose lesions did not contain S. aureus 2 weeks after initiating treatment, beta-defensin levels were higher at both visits than in normal skin. Treatment of uncomplicated impetiginized pediatric AD with topical corticosteroids and cephalexin results in significant clinical improvement, even in subjects infected with MRSA. We propose that the inhibition of abnormal inflammation by the treatment regimen, resulting in the high levels of defensins, is involved in the improvement of AD and that systemic antibiotics do not appear to be necessary in secondary impetiginized AD.

Original languageEnglish
Pages (from-to)289-296
Number of pages8
JournalPediatric Dermatology
Volume29
Issue number3
DOIs
StatePublished - May 2012

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Atopic Dermatitis
Pediatrics
Anti-Bacterial Agents
Staphylococcus aureus
Cephalexin
Methicillin-Resistant Staphylococcus aureus
Adrenal Cortex Hormones
beta-Defensins
Inflammation
Defensins
Therapeutics
Skin
Eczema
Biological Products
Skin Diseases
Cytokines
Peptides
Infection

ASJC Scopus subject areas

  • Dermatology
  • Pediatrics, Perinatology, and Child Health

Cite this

Treatment outcomes of secondarily impetiginized pediatric atopic dermatitis lesions and the role of oral antibiotics. / Travers, Jeffrey; Kozman, Amal; Yao, Yongxue; Ming, Wenyu; Yao, Weiguo; Turner, Mathew J.; Kaplan, Mark; Mousdicas, Nico; Haggstrom, Anita; Saha, Chandan.

In: Pediatric Dermatology, Vol. 29, No. 3, 05.2012, p. 289-296.

Research output: Contribution to journalArticle

Travers, Jeffrey ; Kozman, Amal ; Yao, Yongxue ; Ming, Wenyu ; Yao, Weiguo ; Turner, Mathew J. ; Kaplan, Mark ; Mousdicas, Nico ; Haggstrom, Anita ; Saha, Chandan. / Treatment outcomes of secondarily impetiginized pediatric atopic dermatitis lesions and the role of oral antibiotics. In: Pediatric Dermatology. 2012 ; Vol. 29, No. 3. pp. 289-296.
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