1. bookVolume 65 (2016): Issue 3 (August 2016)
Journal Details
First Published
04 Mar 1952
Publication timeframe
4 times per year
access type Open Access

The Role of Staphylococcus aureus in Secondary Infections in Patients with Atopic Dermatitis (AD)

Published Online: 26 Aug 2016
Volume & Issue: Volume 65 (2016) - Issue 3 (August 2016)
Page range: 253 - 259
Received: 26 Feb 2016
Accepted: 11 Apr 2016
Journal Details
First Published
04 Mar 1952
Publication timeframe
4 times per year

Staphylococcus aureus colonizes the mucous membrane of the nasal vestibule of a significant number of healthy people. These microorganisms are opportunistic pathogens, that in favorable conditions, may cause infections of various course, location or manifestation. Secondary infections emerge in cases when other risk factors contribute to such a change. One of the diseases during which S. aureus changes its saprophytic character to a pathogenic one is atopic dermatitis (AD), an allergic skin condition of a chronic and recurrent nature. Patients with AD are highly predisposed to secondary staphylococcal infections due to active S. aureus colonization of the stratum corneum, damage of the skin barrier or a defective immune response. Microorganisms present in skin lesions destroy the tissue by secreting enzymes and toxins, and additionally stimulate secondary allergic reactions. The toxins secreted by strains of S. aureus also act as superantigens and penetrate the skin barrier contributing to a chronic inflammation of the atopic skin lesions. The S. aureus species also releases proinflam- matory proteins, including enzymes that cause tissue damage. When initiating treatment it is particularly important to properly assess that the onset of the secondary bacterial infection is caused by S. aureus and thus justifying the inclusion of antibiotic therapy. Depending on the severity and extent of the staphylococcal infection, topical antibiotics are used, usually mupirocin or fusidic acid, or general antibiotic treatment is introduced. Another therapeutic strategy without antibiotics has given a positive effect in patients.


Abeck D. and M. Mempel. 1988. Staphylococcus aureus colonization in atopic dermatitis and its therapeutic implications. Br. J. Dermatol. 139 (Suppl 53): 13–16.10.1046/j.1365-2133.1998.1390s3013.x9990408 Search in Google Scholar

Adamek-Guzik T., T.J. Guzik, M. Bzowska, G. Czerniawska- Mysik, D. Szmyd, J. Miedzobrodzki and J. Pryjma. 2001. Selected parameters of the cellular and humoral immunity in atopic dermatitis. Relationship to the severity of the disease (in Polish). Przegl. Lek. 58(12): 1029–1033. Search in Google Scholar

Bogdali M.A., G. Antoszczyk, W. Dyga, A. Obtulowicz, A. Bia- lecka, A. Kasprowicz, Z. Magnowska and K. Obtulowicz. 2016. Nickel allergy and relationship with Staphylococcus aureus in atopic dermatitis. J. Trace. Elem. Med. Biol. 33: 1–7.10.1016/j.jtemb.2016.02.00427049135 Search in Google Scholar

Baran-Raunstrup K., J. Międzobrodzki and T. Ternowitz. 1998. Characteristics of Staphylococcus aureus isolates from atopic dermatitis with reference to proteolytic activity. Acta Microbiol. Pol. 47(2): 167–175. Search in Google Scholar

Boguniewicz M. and D.Y. Leung. 2011. Atopic dermatitis:a disease of altered skin barrier and immune dysregulation. Immunol. Rev. 242(1): 233–246. Search in Google Scholar

Bukowski M., B. Wladyka and G. Dubin. 2010. Exfoliative toxins of Staphylococcus aureus. Toxins (Basel) 2(5): 1148–1165.10.3390/toxins2051148315323722069631 Search in Google Scholar

Bussmann C., S. Weidinger and N. Novak. 2011. Genetics of atopic dermatitis. J. Dtsch. Dermatol. Ges. 9(9): 670–676. Search in Google Scholar

Cavalcante F.S., E.D. Abad, Y.C. Lyra, S.B. , M. Ribeiro, D.C. Ferreira and K.R. dos Santos. 2015. High prevalence of methicillinresistance and PVL genes among Staphylococcus aureus isolates from the nares and skin lesions of pediatric patients with atopic dermatitis. Braz. J. Med. Biol. Res. 48(7): 588–594. Search in Google Scholar

Cheung G.Y., H.S. Joo, S.S. Chatterjee and M. Otto. 2014. Phenol- soluble modulins-critical determinants of staphylococcal virulence. FEMS Microbiol. Rev. 38(4): 698–719. Search in Google Scholar

Cogen A.L., K. Yamasaki, K.M. Sanchez, R.A. Dorschner, Y. Lai, D.T. MacLeod, J.W. Torpey, M. Otto, V. Nizet, J.E. Kim and R.L. Gallo. 2010. Selective antimicrobial action is provided by phenol-soluble modulins derived from Staphylococcus epidermidis, a normal resident of the skin. J. Invest. Dermatol. 130(1): 192–200.10.1038/jid.2009.243279646819710683Search in Google Scholar

Cork M.J., S.G. Danby, Y. Vasilopoulos, J. Hadgraft, M.E. Lane, M. Moustafa, R.H. Guy, A.L. Macgowan, R. Tazi-Ahnini and S.J. Ward. 2009. Epidermal barrier dysfunction in atopic dermatitis. J. Invest. Dermatol. 129: 1892–1908.10.1038/jid.2009.13319494826 Search in Google Scholar

Foelster Holst R., S. Reitamo, R. Yankova, M. Worm, M. Kadu- rina, D. Thaci, T. Bieber, N. Tsankov, A. Enk, T. Luger and others. 2010. The novel protease inhibitor SRD441 ointment is not effective in the treatment of adult subjects with atopic dermatitis: results of a randomized, vehicle-controlled study. Allergy 65(12): 1594–1599.10.1111/j.1398-9995.2010.02417.x21039597Search in Google Scholar

Gelmetti C. 2008. Local antibiotics in dermatology. Derm. Ther. 21: 18.10.1111/j.1529-8019.2008.00190.x18564249Search in Google Scholar

Gloor M., G. Peters and D. Stoika. 1982. On the resident aerobic bacterial skin flora in unaffected skin of patients with atopic dermatitis and in healthy controls. Dermatologica 164(4): 258–265.10.1159/0002500997044853 Search in Google Scholar

Gong J.Q., L. Lin, T. Lin, F. Hao, F.Q. Zeng, Z.G. Bi, D. Yi and Search in Google Scholar

B. Zhao. 2006. Skin colonization by Staphylococcus aureus in patients with eczema and atopic dermatitis and relevant combined topical therapy: a double-blind multicentre randomized controlled trial. Br. J. Dermatol. 155(4): 680–687. Search in Google Scholar

Gordon R.J. and F.D. Lowy. 2008. Pathogenesis of methicillin-resistant Staphylococcus aureus infection. Clin. Infect. Dis. 46(Suppl 5): S350–359.10.1086/533591247445918462090 Search in Google Scholar

Grice E.A. and J.A. Segre. 2011. The skin microbiome. Nat. Rev. Microbiol. 9(4): 244–253. Erratum in: Nat. Rev. Microbiol. 9(8): 626.Search in Google Scholar

Guzik T.J., M. Bzowska, A. Kasprowicz, G. Czerniawska-Mysik, K. Wójcik, D. Szmyd, T. Adamek-Guzik and J. Pryjma. 2005. Persistent skin colonization with Staphylococcus aureus in atopic dermatitis: relationship to clinical and immunological parameters. Clin. Exp. Allergy 35(4): 448–455. Search in Google Scholar

Hanifin J.M. and Rajka G. 1980. Diagnostic features of atopic dermatitis. Acta Derm Venerol. 92: 44. Search in Google Scholar

Hauser C., B. Wuethrich, L. Matter, J.A. Wilhelm, W. Sonnabend and K. Schopfer. 1985. Staphylococcus aureus skin colonization in atopic dermatitis patients. Dermatologica 170: 35–39.10.1159/000249493 Search in Google Scholar

Ide F., T. Matsubara, M. Kaneko, T. Ichiyama, T. Mukouyama and S. Furukawa. 2004. Staphylococcal enterotoxin-specific IgE antibodies in atopic dermatitis. Pediatr. Int. 46(3): 337–341. Search in Google Scholar

Jahreis A., P. Beckheinrich and U.F. Haustein. 2000. Effects of two novel cationic staphylococcal proteins (NP-tase and p70) and enterotoxin B on IgE synthesis and interleukin-4 and interferon-γ production in patients with atopic dermatitis. Br. J. Dermatol.142: 680–687.10.1046/j.1365-2133.2000.03412.x10792217Search in Google Scholar

Kloos W.E. and Schleifer K.H. 1986. Staphylococcus, pp. 431–434. In: Holt J.G. (ed). Bergey’s manual of systematic bacteriology. Williams & Wilkins, New York, USA. Search in Google Scholar

Kobayashi S.D. and F.R. DeLeo. 2009. An update on community associated MRSA virulence. Curr. Opin. Pharmacol. 9(5): 545–551.Search in Google Scholar

Krishna S. and L.S. Miller. 2012. Host-pathogen interactions between the skin and Staphylococcus aureus. Curr. Opin. Microbiol. 15(1): 28–35. Search in Google Scholar

Leung D.Y., M. Boguniewicz, M.D. Howell, I. Nomura and Q.A. Hamid. 2004. New insights into atopic dermatitis. J. Clin. Invest. 113(5): 651–657. Search in Google Scholar

Leyden J.J., R.R. Marples and A.M. Kligman. 1974. Staphylo coccus aureus in the lesions of atopic dermatitis. Br. J. Dermatol. 90(5): 525–530. Search in Google Scholar

Lis G., E. Cichocka-Jarosz, D. Gazurek, T. Szczerbiński, I. Głodzik, P. Sawiec and B. Białoruska. 2002. Relationships between atopy and bronchial hyper-reactivity in Polish school age children (in Polish). Przegl. Lek. 59(10): 780–784. Search in Google Scholar

Lomholt H., K.E. Andersen and M. Kilian. 2005. Staphylococcus aureus clonal dynamics and virulence factors in children with atopic dermatitis. J. Invest. Dermatol. 125(5): 977–982. Search in Google Scholar

Lübbe J. 2003. Secondary infections in patients with atopic dermatitis. Am. J. Clin. Dermatol. 4( 9): 641–654.10.2165/00128071-200304090-0000612926982 Search in Google Scholar

Matsubara M., D. Harada, H. Manabe and K. Hasegawa. 2004. Staphylococcus aureus peptidoglycan stimulates granulocyte macrophage colony-stimulating factor production from human epidermal keratinocytes via mitogen-activated protein kinases. J. Invest. Dermatol. 566(1-3): 195–200.10.1016/j.febslet.2004.04.02815147894 Search in Google Scholar

Międzobrodzki J., A.S. Naidu, J.L. Watts, P. Ciborowski, K. Palm and T. Wadstrom. 1989. Influence of milk on fibronectin and collagen type I binding to Staphylococcus aureus and coagulase-negative staphylococci isolated from Bovine mastitis. J. Clin. Microbiol. 27: 540–544.10.1128/jcm.27.3.540-544.19892673542775349 Search in Google Scholar

Międzobrodzki J. and P. Kaszycki. 2000. Modyfication of Reactive- Oxygen intermediates (ROi) production by monocyte/macrophage treated with Staphylococcus aureus serine protease. Acta Microbiol. Pol. 49: 237–242 Search in Google Scholar

Międzobrodzki J., P. Kaszycki, A. Białecka and A. Kasprowicz. 2002. Proteolytic activity of Staphylococcus aureus strains isolated from the colonized skin of patients with acute-phase atopic dermatitis. Eur. J. Clin. Microbiol. Infect. Dis. 21: 269–276.10.1007/s10096-002-0706-412072937 Search in Google Scholar

Miedzobrodzki J., T. Panz, P.M. Płonka, K. Zajac, J. Dracz, K. Pytel, Ł. Mateuszuk and S. Chłopicki. 2008. Platelets augment respiratory burst in neutrophils activated by selected species of gram-positive or gram-negative bacteria. Folia Histochem. Cytobiol. 46(3): 383–388. Search in Google Scholar

Na S.Y., J.Y. Roh, J.M. Kim, M.D. Tamang and J.R. Lee. 2012. Analysis of colonization and genotyping of the exotoxins of Staphylococcus aureus in patients with atopic dermatitis. Ann. Dermatol. 24(4): 413–419. Search in Google Scholar

Naidu A.S., J. Miedzobrodzki and A. Forsgren. 1991. Human lactoferrin binding in clinical isolates of Staphylococcus aureus. J. Med. Microbiol. 34: 323–328.10.1099/00222615-34-6-3232056516 Search in Google Scholar

Nakamura Y., J. Oscherwitz, K.B. Cease, S.M. Chan, R. Muñoz- Planillo, M. Hasegawa, A.E. Villaruz, G.Y. Cheung, M.J. McGavin, J.B. Travers and others. 2013. Staphylococcus δ-toxin induces allergic skin disease by activating mast cells. Nature 503(7476): 397–401.10.1038/nature12655409078024172897Search in Google Scholar

Nutten S. 2015. Atopic dermatitis: global epidemiology and risk factors. Ann. Nutr. Metab. 66(Suppl 1):8–16.10.1159/00037022025925336 Search in Google Scholar

Orfali R.L., M.N. Sato, V.G. Santos, T.O. Titz, C.A. Brito, A.J. Duarte, R. Takaoka and V. Aoki. 2015. Staphylococcal enterotoxin B induces specific IgG4 and IgE antibody serum levels in atopic dermatitis. Int. J. Dermatol. 54(8): 898–904. Search in Google Scholar

Otto M. 2014. Staphylococcus aureus toxins. Curr. Opin. Microbiol. 17: 32–37.10.1016/j.mib.2013.11.004394266824581690 Search in Google Scholar

Palmer C.N., A.D. Irvine, A. Terron-Kwiatkowski, Y. Zhao, H. Liao, S.P. Lee, D.R. Goudie, A. Sandilands, L.E. Campbell, F.J. Smith and others. 2006. Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis. Nat. Genet. 38: 441–446.10.1038/ng176716550169 Search in Google Scholar

Petry V., G.R. Bessa, C.S. Poziomczyck, C.F. Oliveira, M.B. Weber, R.R. Bonamigo and P.A. d’Azevedo. 2012. Bacterial skin colonization and infections in patients with atopic dermatitis. An. Bras. Dermatol. 87(5): 729–734. Search in Google Scholar

Reginald K., K. Westritschnig, T. Werfel, A. Heratizadeh, N. Novak, M. Focke-Tejkl, A.M. Hirschl, D.Y. Leung, O. Elisyu- tina, E. Fedenko and others. 2011. Immunoglobulin E antibody reactivity to bacterial antigens in atopic dermatitis patients. Clin. Exp. Allergy 41(3): 357–369. Search in Google Scholar

Ring J., A. Alomar, T. Bieber, M. Deleuran, A. Fink-Wagner, Search in Google Scholar

C. Gelmetti, U. Gieler, J. Lipozencic, T. Luger, A.P. Oranje and others. 2012. Guidelines for treatment of atopic eczema (atopic dermatitis). Part I. J. Eur. Acad. Dermatol. Venereol. 26(8): 1045–1060.Search in Google Scholar

Ring J., D. Abeck and K. Neuber. 1992. Atopic eczema: role of microorganisms on the skin surface. Allergy 47(4 Pt 1): 265–269.10.1111/j.1398-9995.1992.tb02051.x1443443 Search in Google Scholar

Rojo A., A. Aguinaga, S. Monecke, J.R. Yuste, G. Gastaminza and A. España. 2014. Staphylococcus aureus genomic pattern and atopic dermatitis: may factors other than superantigens be involved? Eur. J. Clin. Microbiol. Infect. Dis. 33(4): 651–658. Search in Google Scholar

Roll A., A. Cozzio, B. Fischer and P. Schmid-Grendelmeier. 2004. Microbial colonization and atopic dermatitis. Curr. Opin. Allergy Clin. Immunol. 4: 373–378.10.1097/00130832-200410000-0000815349036 Search in Google Scholar

Sabat A.J., B. Wladyka., K. Kosowska-Shick, H. Grundmann, J.M. van Dijl, J. Kowal, P.C. Appelbaum, A. Dubin and W. Hrynie- wicz. 2008. Polymorphism, genetic exchange and intragenic recombination of the aureolysin gene among Staphylococcus aureus strains. BMC Microbiol. 29(8): 129.10.1186/1471-2180-8-129251584918664262 Search in Google Scholar

Schlievert P.M., L.C. Case, K.L. Strandberg, B.B. Abrams and Search in Google Scholar

D.Y. Leung. 2008. Superantigen profile of Staphylococcus aureus isolates from patients with steroid-resistant atopic dermatitis. Clin. Infect. Dis. 46(10): 1562–1567. Search in Google Scholar

Schlievert P.M., K.L. Strandberg, Y.C. Lin, M.L. Peterson and D.Y. Leung. 2010. Secreted virulence factor comparison between methicillin-resistant and methicillin-sensitive Staphylococcus aureus, and its relevance to atopic dermatitis. J. Allergy Clin. Immunol. 125(1): 39–49. Search in Google Scholar

Soares J., C. Lopes, F. Tavaria, L. Delgado and M. Pintado. 2013. A diversity profile from the staphylococcal community on atopic dermatitis skin: a molecular approach. J. Appl. Microbiol. 115(6): 1411–1419.Search in Google Scholar

Sonesson A., J. Bartosik, J. Christiansen, I. Roscher, F. Nilsson, A. Schmidtchen and O. Bäck. 2013. Sensitization to skin-associated microorganisms in adult patients with atopic dermatitis is of importance for disease severity. Acta Derm. Venereol. 93(3): 340–345.10.2340/00015555-146523073977 Search in Google Scholar

Sybilski A.J., F. Raciborski, A. Lipiec, A. Tomaszewska, A. Lusawa, P. Samel-Kowalik, A. Walkiewicz, E. Krzych, J. Komorowski and B. Samoliński. 2015. Atopic dermatitis is a serious health problem in Poland. Epidemiology studies based on the ECAP study (in Polish). Postepy Dermatol. Alergol. 32(1): 1–10. Search in Google Scholar

Ternowitz T. and T. Herlin. 1986. Defective monocyte and polymorphonuclear leukocyte chemotaxis and clinical characteristics in atopic dermatitis. Arch. Dermatol. Res. 278(6): 454–459. Search in Google Scholar

Werfel T. 2009. The role of leukocytes, keratinocytes, and allergenspecific IgE in the development of atopic dermatitis. J. Invest. Dermatol. 129: 1878–1891. Search in Google Scholar

Wilburg J., A. Kasprowicz and P.B. Heczko. 1984. Composition of normal bacterial flora of human skin in relation to the age and sex of examined persons (in Polish). Przegl. Dermatol. 71(6): 551–557. Search in Google Scholar

Recommended articles from Trend MD

Plan your remote conference with Sciendo