Guzik T J, Bzowska M, Kasprowicz A, Czerniawska-Mysik G, Wójcik K, Szmyd D, Adamek-Guzik T, Pryjma J
Department of Medicine, Jagiellonian University of Medicine, Cracow, Poland.
Clin Exp Allergy. 2005 Apr;35(4):448-55. doi: 10.1111/j.1365-2222.2005.02210.x.
Staphylococcus aureus has important implications for the pathogenesis of atopic dermatitis (AD). In some patients S. aureus can be eradicated from the skin during anti-inflammatory treatment, while in others bacterial colonization is persistent. Potential mechanisms and features of these two distinct groups of patients are not known.
Accordingly, we studied relationships between the ability to eliminate S. aureus during an anti-inflammatory treatment and selected clinical and immunological features.
Quantitative assessment of S. aureus on the skin, in nasal vestibule and throat, serum IgE levels, CD4/CD8 T-cell ratio, lymphocyte proliferation and phagocyte oxidative burst were determined during the exacerbation and after 4 and 12 weeks of the treatment using topical steroid and oral antihistamine in 34 patients with AD.
S. aureus was found on the skin of all 34 patients during exacerbation. Disease severity scoring of atopic dermatitis (SCORAD) correlated with the density of bacteria. Treatment with oral antihistamine and topical steroid resulted in a significant alleviation of symptoms, which correlated with the elimination of S. aureus from the skin in 70% of patients. In the remaining 30% of patients, dense (more than 10(10)/cm2) S. aureus skin colonization, persisted despite the treatment. Patients with persistent S. aureus presented with higher serum IgE levels, lower lymphocyte proliferation in response to staphylococcal enterotoxin B, phytohaemagluttinin and anti-CD3. Persistence of S. aureus was more common in men.
Patients with AD differ in the ability to clear S. aureus from the skin during anti-inflammatory treatment, which appears to be related to the abnormalities in immunological parameters. Local antibiotic therapy should be considered only in patients with persistent S. aureus colonization.
金黄色葡萄球菌在特应性皮炎（AD）的发病机制中具有重要意义。在一些患者中，金黄色葡萄球菌可在抗炎治疗期间从皮肤中清除，而在另一些患者中细菌定植持续存在。这两组不同患者的潜在机制和特征尚不清楚。
因此，我们研究了抗炎治疗期间清除金黄色葡萄球菌的能力与选定的临床和免疫学特征之间的关系。
对34例AD患者在病情加重期以及使用局部类固醇和口服抗组胺药治疗4周和12周后，对皮肤、鼻前庭和咽喉部的金黄色葡萄球菌进行定量评估，测定血清IgE水平、CD4/CD8 T细胞比值、淋巴细胞增殖和吞噬细胞氧化爆发。
在病情加重期，所有34例患者的皮肤均发现有金黄色葡萄球菌。特应性皮炎疾病严重程度评分（SCORAD）与细菌密度相关。口服抗组胺药和局部类固醇治疗使症状明显缓解，70%的患者症状缓解与皮肤中金黄色葡萄球菌的清除相关。在其余30%的患者中，尽管进行了治疗，皮肤中仍存在密集（超过10(10)/cm2）的金黄色葡萄球菌定植。金黄色葡萄球菌持续存在的患者血清IgE水平较高，对葡萄球菌肠毒素B、植物血凝素和抗CD3刺激的淋巴细胞增殖较低。金黄色葡萄球菌持续存在在男性中更为常见。
AD患者在抗炎治疗期间从皮肤清除金黄色葡萄球菌的能力存在差异，这似乎与免疫参数异常有关。仅对金黄色葡萄球菌持续定植的患者应考虑局部抗生素治疗。
