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Skin microflora of atopic eczema in first time hospital attenders
H M Goodyear1, P J Watson, S A Egan
1Department of Paediatric Dermatology, Queen Elizabeth Hospital for Children, London, UK.
Insights
Children with eczema show significantly higher levels of skin bacteria, particularly Staphylococcus aureus, compared to healthy children. Bacterial density correlates with eczema severity, and many strains exhibit antibiotic resistance.
Area of Science:
- Dermatology
- Microbiology
- Pediatrics
Background:
- Eczema, a common inflammatory skin condition, is often associated with bacterial skin colonization.
- Understanding the specific bacterial flora in children with eczema is crucial for effective management.
Purpose of the Study:
- To quantitatively assess and compare the skin bacterial flora in children with eczema versus non-atopic controls.
- To identify the predominant bacterial species, particularly Staphylococcus aureus, and their colonization sites.
- To investigate the relationship between bacterial density, eczema severity, and antibiotic resistance patterns.
Main Methods:
- Quantitative bacterial assessment using cotton-tipped swabs and contact agar discs from affected and unaffected skin sites in 50 children with eczema and 20 controls.
- Swabs also collected from nose, axilla, and groin for comprehensive flora analysis.
- Isolation and identification of bacterial species, including Staphylococcus aureus, with phage typing and antibiotic susceptibility testing.
Main Results:
- Significantly higher prevalence and quantity of skin bacterial colonization in children with eczema compared to controls.
- Staphylococcus aureus was the most common pathogen, isolated from 74% of eczema lesions and 30% of unaffected skin sites.
- Bacterial density was directly proportional to eczema severity.
- Staphylococcus aureus phage group II was most common (32%); 88% of strains were penicillin-resistant, and 38% were resistant to multiple antibiotics.
Conclusions:
- Children with eczema exhibit increased and denser skin bacterial colonization, especially by Staphylococcus aureus.
- The findings highlight the importance of addressing bacterial load and antibiotic resistance in eczema management.
- Further research into the clinical implications of specific S. aureus phage groups and resistance patterns is warranted.
Abstract:
The bacterial flora of the skin was assessed quantitatively in 50 children with eczema, aged 6 months to 14 years, referred to the hospital for the first time. Twenty nonatopic controls with an unrelated non-infective disorder were also studied. Cotton-tipped swabs and contact agar discs were taken from the worst affected area of eczema and from an uninvolved site in patients and from the forearm in controls. Swabs were also taken from the nose, axilla and groin in all children. Bacterial colonization of the skin was consistently more common and greater in amount from patients compared with controls. Staphylococcus aureus was the most common pathogen isolated from patients only; from the worst affected area of eczema in 74% of patients and from an uninvolved skin site in 30% of patients. Quantitative assessment showed that the density of colonization was proportional to the severity of eczema. The most common S. aureus phage group was group II accounting for 32% of strains. Resistance to penicillin was present in 88% of strains and to two or more antibiotics in 38% of strains. No relationship was noted between the pattern of resistance and phage group.