Patients with Atopic Dermatitis Colonized with Staphylococcus Aureus Have a Distinct Phenotype and Endotype

Overview

Journal J Invest Dermatol

Publisher Elsevier

Specialty Dermatology

Date 2018 Apr 1

PMID 29604251

Citations 69

Authors

Eric L Simpson

Miguel Villarreal

Brett Jepson

Nick Rafaels

Gloria David

Jon Hanifin

Patricia Taylor

Mark Boguniewicz

Takeshi Yoshida

Anna De Benedetto

Kathleen C Barnes

Donald Y M Leung

Lisa A Beck

Affiliations

Soon will be listed here.

Abstract

Patients with atopic dermatitis (AD) are commonly colonized with Staphylococcus aureus (AD S. aureus), but what differentiates this group from noncolonized AD patients (AD S. aureus) has not been well studied. To evaluate whether these two groups have unique phenotypic or endotypic features, we performed a multicenter, cross-sectional study enrolling AD S. aureus (n = 51) and AD S. aureus (n = 45) participants defined by the presence or absence of S. aureus by routine culture techniques and nonatopic, noncolonized control individuals (NA S. aureus) (n = 46). Filaggrin (FLG) genotypes were determined, and disease severity (Eczema Area and Severity Index, Rajka-Langeland Severity Score, Investigator's Global Assessment score, Numerical Rating Scale, and Dermatology Life Quality Index) was captured. Skin physiology was assessed (transepidermal water loss [TEWL], stratum corneum integrity, hydration, and pH), and serum biomarkers were also measured. We found that AD S. aureus patients had more severe disease based on all scoring systems except itch (Numerical Rating Scale), and they had higher levels of type 2 biomarkers (eosinophil count, tIgE, CCL17, and periostin). Additionally, AD S. aureus patients had significantly greater allergen sensitization (Phadiatop and tIgE), barrier dysfunction (TEWL and stratum corneum integrity), and serum lactate dehydrogenase (LDH) than both the AD S. aureus and NA S. aureus groups. FLG mutations did not associate with S. aureus colonization. In conclusion, adult patients with AD who are colonized on their skin with S. aureus have more severe disease, greater type 2 immune deviation, allergen sensitization, barrier disruption, and LDH level elevation than noncolonized patients with AD.

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