INTRODUCTION
Atopic dermatitis (AD), or atopic eczema, is a chronic and relapsing inflammatory skin disorder. It affects a substantial portion of the population, with prevalence up to 10% in adults and up to 20% in children.1,2 AD is characterized by itching, dry skin, and impaired skin barrier function.3 Most of these conditions are worsened by skin infections, especially methicillin-resistant Staphylococcus aureus (MRSA) infection. The prevalence of MRSA infections among AD patients ranges from 13% to as high as 25%, while this range is 1% to 3% among the general population.4,5
The elevated colonization rate is attributable to a combination of factors related to AD. These include impaired skin barrier function, decreased antimicrobial peptides, microbiome imbalance, reduced levels of filaggrin and its degradation products, increased skin pH, overexpression of Th2/Th17 cytokines, and changes in lipid composition.6 Further, MRSA infections are in turn associated with increased disease severity, demonstrated by higher Eczema Area Severity Index (EASI) scores in AD patients with these infections.4 These pathogens produce virulence factors, which are associated with increased inflammation and further disruption of skin barrier function.6
Current treatment approaches for MRSA infections in AD patients include topical or oral antibiotics.8 In a study evaluating various antibiotics against S. aureus and MRSA isolated from AD patients, there was concern regarding the increasing resistance of these pathogens to current antibiotic therapies, with the authors suggesting more cautious use and reduced treatment periods. Notably, AD-derived S. aureus isolates had marked increases in resistance to therapies currently used for AD patients, such as mupirocin and fusidic acid.7 Additionally, S. aureus infections are often recurrent among AD patients, which can necessitate the use of decolonization approaches such as bleach baths to attempt to reduce the pathogen burden, but the demonstrated efficacy of this approach remains limited.8 In previous studies, results showed that bleach baths may offer benefits only in the reduction of AD severity without reducing S. aureus colonization.9
The elevated colonization rate is attributable to a combination of factors related to AD. These include impaired skin barrier function, decreased antimicrobial peptides, microbiome imbalance, reduced levels of filaggrin and its degradation products, increased skin pH, overexpression of Th2/Th17 cytokines, and changes in lipid composition.6 Further, MRSA infections are in turn associated with increased disease severity, demonstrated by higher Eczema Area Severity Index (EASI) scores in AD patients with these infections.4 These pathogens produce virulence factors, which are associated with increased inflammation and further disruption of skin barrier function.6
Current treatment approaches for MRSA infections in AD patients include topical or oral antibiotics.8 In a study evaluating various antibiotics against S. aureus and MRSA isolated from AD patients, there was concern regarding the increasing resistance of these pathogens to current antibiotic therapies, with the authors suggesting more cautious use and reduced treatment periods. Notably, AD-derived S. aureus isolates had marked increases in resistance to therapies currently used for AD patients, such as mupirocin and fusidic acid.7 Additionally, S. aureus infections are often recurrent among AD patients, which can necessitate the use of decolonization approaches such as bleach baths to attempt to reduce the pathogen burden, but the demonstrated efficacy of this approach remains limited.8 In previous studies, results showed that bleach baths may offer benefits only in the reduction of AD severity without reducing S. aureus colonization.9
