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Updated: Jul 3, 2026

Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)
Published on: February 9, 2011
Atopic dermatitis complicated by methicillin-resistant Staphylococcus aureus infection
Kam-Lun Ellis Hon1, Alexander K C Leung, Albert Y F Kong
1Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China. ehon@cuhk.edu.hk
Introduction:
Staphylococcus aureus colonization/infection is commonly associated with disease severity in children with atopic dermatitis. The present report is a three-year retrospective chart review of five cases (comprising three boys and two girls, aged 9-15 years at referral) of methicillin-resistant S. aureus (MRSA) in children with moderate-to-severe atopic dermatitis. The review period spanned 2004-2007. All had longstanding severe disease, high IgE and eosinophil counts. Generalized erythema and a peculiar fishy odor were frequently observed by parents and physicians when MRSA was isolated during some of the episodes of exacerbation. All had tried various combinations of topical and systemic steroids, topical immunomodulants, traditional Chinese medicine and courses of antibiotics-without lasting relief. All specimens of MRSA had in-vitro sensitivity to vancomycin, with corresponding clinical correlates of disappearance of the erythema and fishy odor.
Conclusion:
A fishy odor and facial/generalized erythema in a patient with atopic dermatitis should alert the physician to screen for MRSA. The organism is rarely isolated, even among children with moderate-to-severe atopic dermatitis, and is usually sensitive to vancomycin.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) can cause severe atopic dermatitis in children. Early screening for MRSA is crucial, as vancomycin effectively treats infections, resolving symptoms like erythema and odor.
Area of Science:
- Pediatric Dermatology
- Infectious Diseases
- Microbiology
Background:
- Staphylococcus aureus colonization is linked to atopic dermatitis severity in children.
- This report reviews five pediatric cases of methicillin-resistant S. aureus (MRSA) with moderate-to-severe atopic dermatitis.
- Patients presented with severe, long-standing disease, elevated IgE and eosinophils.
Purpose of the Study:
- To describe clinical characteristics and treatment outcomes of MRSA in children with atopic dermatitis.
- To highlight potential diagnostic indicators of MRSA infection in this population.
Main Methods:
- Retrospective chart review of five pediatric patients diagnosed with MRSA between 2004-2007.
- Analysis of clinical presentation, laboratory findings, and treatment responses.
Main Results:
- Generalized erythema and a distinct fishy odor were frequently noted during MRSA exacerbations.
- Patients had failed multiple prior treatments, including steroids and antibiotics.
- All MRSA isolates were sensitive to vancomycin, with treatment leading to symptom resolution.
Conclusions:
- A fishy odor and erythema in pediatric atopic dermatitis warrant MRSA screening.
- MRSA is infrequently isolated but treatable with vancomycin, which resolves associated symptoms.
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