Chronic cutaneous bacterial hypersensitivity

Chronic cutaneous bacterial hypersensitivity (CCBH) is a syndrome of recurrent indolent inflammatory lesions that are caused by a hypersensitivity reaction to skin flora. It can cause significant physical and social distress to those affected, who often endure years of nondiagnostic evaluations and ineffective treatments. We report two additional cases of this syndrome. Skin testing demonstrated IgE to bacterial antigens in both patients, and ELISA demonstrated both IgE and IgG to bacterial antigens in one patient. Both patients improved rapidly and dramatically with oral corticosteroid therapy, although they failed to achieve a lasting remission, as had been seen in previous cases. These represent the fourth and fifth reported cases of CCBH. Despite failure to achieve remission, these patients demonstrate the effectiveness of an inexpensive and safe prednisone regimen in controlling this physically and socially destructive disease.