Combined Antibiotic/Corticosteroid Cream in the Empirical Treatment of Moderate to Severe Eczema: Friend or Foe?
July 2012 | Volume 11 | Issue 7 | Original Article | 861 | Copyright © 2012
Background: 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.
Aim: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
J Drugs Dermatol. 2012;11(7):861-864.
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Atopic eczema (AE) is a common chronic relapsing disease in children. It was estimated that about 15% of children suffer from this disease.1-3 Bacterial colonization/infection due to Staphylococcus aureus is considered an important factor in the pathophysiology and mechanism involved in AE exacerbation. 4,5 We aim to a) review the bacteriology and antimicrobial sensitivity in patients with moderate to severe AE and b) to evaluate the efficacy and acceptability of a combined antibiotic/ corticosteroid cream in the empirical treatment of eczema.
Consecutive AE patients with moderate to severe eczema were recruited at the pediatric dermatology clinic of a university teaching hospital from June 2010 to February 2011. Atopic eczema is diagnosed according to Hanifin and Rajka's criteria.6 Patients were excluded from the study if they suffered from other inflammatory dermatitides (eg, psoriasis, seborrheic dermatitis, ichthyosis) or had been treated with systemic antibiotics (such as cloxacillin or erythromycin) in the previous 4 weeks. Standard swabs and cultures from the right antecubital fossa and the worst eczematous area (5 seconds of rubbing) were taken.7 Bacterial cultures of the swabs were carried out by standard laboratory techniques and sensitivity towards common antibiotics examined. Bacterial growth was classified as scanty (<104 colony-forming units per mL), moderate (104 to 105), or heavy (>105). In addition, disease severity (by SCORAD and Nottingham Eczema Severity Score NESS),8-11 quality of life (by Children Dermatology Life Quality Index CDLQI),11,12 skin hydration (SH), and transepidermal water loss (TEWL) at the right antecubital fossa13,14 were obtained prior to and following a two-week twice-daily course of treatment with a fucidin/corticosteroid cream (Fucicort®: fusidic acid 2% w/w and betamethasone valerate 0.1% w/w; LEO Pharmaceutical Products Ltd., Denmark). General acceptability of treatment (GAT) was documented at completion.14
SCORAD is a widely used score in eczema research that evaluates eczema severity over a one-week period and NESS is a simple and easy to perform score that assesses the symptomatology of eczema over the preceding 12 months.8-11 A validated Cantonese version of NESS is available.9-11 Skin hydration and TEWL were