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Skin barrier impairment correlates with cutaneous S taphylococcus aureus colonization and sensitization to skin‐associated microbial antigens in adult patients with atopic dermatitis
Author(s) -
Jinnestål Camilla Ling,
Belfrage Emma,
Bäck Ove,
Schmidtchen Artur,
Sonesson Andreas
Publication year - 2014
Publication title -
international journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 93
eISSN - 1365-4632
pISSN - 0011-9059
DOI - 10.1111/ijd.12198
Subject(s) - staphylococcus aureus , atopic dermatitis , sensitization , transepidermal water loss , medicine , colonization , immunology , skin infection , immunoglobulin e , malassezia , microbiology and biotechnology , candida albicans , dermatology , biology , bacteria , antibody , pathology , stratum corneum , genetics
Background Atopic dermatitis ( AD ) is a chronic inflammatory skin disease. The pathogenesis of AD involves skin barrier defects and dysregulation of innate and adaptive immunity. Some environmental factors such as stress, infections, and allergens are associated with aggravation of AD . The aim of the study was to investigate the relationship between skin barrier function, skin colonization of S taphylococcus aureus , and sensitization to antigens of skin‐associated microorganisms in adult patients with AD . Methods Thirty adult patients with AD and 10 controls were recruited. Eczema severity was assessed, and transepidermal water loss ( TEWL ) was measured. Bacterial samples were taken from the skin using a swab technique for qualitative identification of S . aureus and a contact agar disc method for quantitative assessment. Immunological analyses of specific I g E to staphylococcal enterotoxins and yeasts as well as total serum I g E levels, were performed. Results TEWL was significantly higher among S . aureus ‐positive patients in comparison to S . aureus ‐negative patients with AD ( P < 0.05). TEWL increased with increasing bacterial load ( P = 0.018). In the group of patients sensitized to all three of the investigated skin‐associated microorganisms ( S . aureus , M alassezia , and C andida ), an increased TEWL was observed, in comparison to patients sensitized to none, or one or two ( P = 0.026). Conclusion In adult patients with AD , a disrupted skin barrier promotes skin colonization by microbes, such as S . aureus . Heavy microbial colonization may facilitate skin penetration of microbial antigens leading to subsequent I g E sensitization. These results illustrate the importance of skin‐associated microbial colonization and sensitization to microbial‐derived allergens in eczema pathogenesis.