Hon Kam Lun, Wang Shuxin Susan, Lee Kenneth K C, Lee Vivian W Y, Leung Ting Fan, Ip Margaret
Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
J Drugs Dermatol. 2012 Jul;11(7):861-4.
Eczema is a common atopic disease associated with pruritus, sleep disturbance, and impaired quality of life. Staphylococcus aureus colonization/infection is important in its pathophysiology.
To evaluate the prevalence of S aureus colonization/infection and the efficacy and acceptability of a combined antibiotic/corticosteroid cream in the empirical treatment of eczema.
Consecutive patients with moderate to severe eczema were recruited. Swab and cultures from the right antecubital fossa and the worst eczematous area, disease severity (SCORAD) and quality of life (Children's Dermatology Life Quality Index, CDLQI), skin hydration (SH), and transepidermal water loss (TEWL) were obtained prior to and following a two week twice-daily course of treatment with a fucidin/corticosteroid cream. General acceptability of treatment (GAT) was documented at completion.
Thirty-five patients (63% males; mean age 13.5, standard deviation 3.6 years; with 21 moderate and 14 severe disease) were recruited. At start, S aureus was isolated from the right antecubital fossa and the worst affected areas in 66% and 71% of these patients, respectively. At completion, S aureus was isolated in 23% and 40% at the antecubital fossae and worst affected areas (P=0.001 and P=0.003, respectively). No methicillin-resistant S aureus was isolated in this series, but the percentage of fucidin-resistant S aureus increased from 8% to 58% (P<0.001). Disease severity and quality of life were significantly improved (pre-Objective SCORAD and post-Objective SCORAD were 38.4±13.7 and 29.7±14.2, P<0.001; pre-CDLQI and post-CDLQI were 9.4±5.2 and 7.1±4.8, P<0.001). At the right antecubital fossa, skin hydration improved from 30.8±14.2 to 36.7±15.2 (P=0.015); and TEWL from 10.7±2.3 to 9.4±2.2 (P<0.001). Eighty percent of patients found the treatment good or very good, and only one (3%) patient found it unacceptable.
The most prevalent organism in moderate to severe eczema was S aureus. Usage of the combined fucidin/corticosteroid cream is convenient and associated with a reduction in disease severity, improvement in quality of life, SH, and TEWL, but caution has to be taken with emergence of fucidin-resistant S aureus.
湿疹是一种常见的特应性疾病，伴有瘙痒、睡眠障碍和生活质量受损。金黄色葡萄球菌定植/感染在其病理生理过程中起重要作用。
评估金黄色葡萄球菌定植/感染的患病率，以及一种抗生素/皮质类固醇联合乳膏在湿疹经验性治疗中的疗效和可接受性。
招募中度至重度湿疹的连续患者。在使用夫西地酸/皮质类固醇乳膏进行为期两周、每日两次的治疗之前和之后，获取右肘前窝和最严重湿疹部位的拭子及培养物、疾病严重程度（SCORAD）和生活质量（儿童皮肤病生活质量指数，CDLQI）、皮肤水合作用（SH）和经表皮水分流失（TEWL）。治疗结束时记录治疗的总体可接受性（GAT）。
招募了35名患者（63%为男性；平均年龄13.5岁，标准差3.6岁；21例中度疾病和14例重度疾病）。开始时，分别在66%和71%的这些患者的右肘前窝和最严重受累部位分离出金黄色葡萄球菌。结束时，在肘前窝和最严重受累部位分离出金黄色葡萄球菌的比例分别为23%和40%（分别为P = 0.001和P = 0.003）。本系列中未分离出耐甲氧西林金黄色葡萄球菌，但耐夫西地酸金黄色葡萄球菌的比例从8%增加到58%（P < 0.001）。疾病严重程度和生活质量显著改善（治疗前客观SCORAD和治疗后客观SCORAD分别为38.4±13.7和29.7±14.2，P < 0.001；治疗前CDLQI和治疗后CDLQI分别为9.4±5.2和7.1±4.8，P < 0.001）。在右肘前窝，皮肤水合作用从30.8±14.2改善至36.7±15.2（P = 0.015）；TEWL从10.7±2.3改善至9.4±2.2（P < 0.001）。80%的患者认为治疗良好或非常好，只有1名（3%）患者认为不可接受。
中度至重度湿疹中最常见的病原体是金黄色葡萄球菌。使用夫西地酸/皮质类固醇联合乳膏方便，且与疾病严重程度降低、生活质量改善、SH和TEWL改善相关，但必须注意耐夫西地酸金黄色葡萄球菌的出现。
