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Bacterial infection and atopic eczema
Insights
Bacterial infections frequently worsen atopic eczema in children, often with recurring episodes. Early antibiotic treatment may be beneficial for severe cases, even with unclear infection signs.
Area of Science:
- Pediatric Dermatology
- Infectious Diseases in Children
- Clinical Immunology
Background:
- Atopic eczema is a chronic inflammatory skin condition common in children.
- Bacterial infections are known complications that can exacerbate atopic eczema.
- The diagnostic signs and management of bacterial infections in atopic eczema require further clarification.
Purpose of the Study:
- To prospectively investigate the incidence and characteristics of bacterial infections exacerbating atopic eczema in children.
- To identify common bacterial pathogens involved in eczema exacerbations.
- To evaluate the clinical presentation and inform treatment strategies for infected atopic eczema.
Main Methods:
- Prospective study of 190 children with atopic eczema over 2.5 years (mean 13 months observation).
- Detailed recording of eczema exacerbations, suspected bacterial infections, and treatment responses.
- Microbiological analysis to identify causative pathogens, primarily Staphylococcus aureus and beta-hemolytic streptococci.
Main Results:
- Bacterial infection exacerbated atopic eczema in 40% of children, with 32% experiencing recurrent infections.
- Staphylococcus aureus was identified in 97% of infectious episodes, often with beta-hemolytic streptococci (62%).
- Clinical signs like pustules and crusting were indicative but not solely diagnostic; response to antibiotics was key.
Conclusions:
- Bacterial infection is a common and significant factor in atopic eczema exacerbations in children.
- Diagnostic clinical signs may be ambiguous, necessitating a clinical response to anti-infective therapy for confirmation.
- A trial of oral antibiotics is warranted for children with severe or troublesome atopic eczema flares.
Abstract:
One hundred and ninety children with atopic eczema were studied prospectively for two and a half years. The mean period of observation was 13 months. Seventy six children (40%) had between them 164 episodes of exacerbation of eczema due to bacterial infection, and in 52 (32%) infection recurred within three months of a previous infection. Twenty five episodes (15%) led to admission to hospital. Staphylococcus aureus was recovered in 97% of episodes, in combination with beta haemolytic streptococci in 62%. Physical signs suggesting infection were pustules, crusting, and a weeping discharge, but these signs alone are not diagnostic, and an exacerbation was only attributed to infection if there was a response to anti-infective treatment. Exacerbation of atopic eczema due to bacterial infection is common, the physical signs of infection are not always clear, and there is a case for a trial of oral antibiotics in any child with troublesome atopic eczema.