Staphylococcus aureus carriage in the anterior nares of close contacts of patients with atopic dermatitis.

OBJECTIVE: To study the prevalence of Staphylococcus aureus colonization in close contacts of patients with atopic dermatitis (AD) and the influence on AD severity. DESIGN: Prospective case-control study. SETTING: Pediatric dermatology clinic in a Hong Kong university hospital. Patients We recruited 211 subjects prospectively, including 50 AD patients, 50 non-AD control subjects, 60 close contacts of AD patients, and 51 close contacts of controls. Intervention Nasal swabs and skin swabs were taken. Severity of AD was assessed using the SCORAD (Scoring Atopic Dermatitis) index. MAIN OUTCOME MEASURES: The prevalence of S aureus colonization in the close contacts of AD patients was compared with that of the close contacts of non-AD controls. Between-group differences were assessed, where appropriate, by unpaired t test or Pearson chi(2) test. Multivariate logistic regression using the forward stepwise method was performed to identify independent predictors of severe AD. A probability value of P < .05 was considered statistically significant. RESULTS: Significantly more nasal carriers of S aureus were found among the close contacts of AD patients (14 of 60 [23%]) than among the close contacts of non-AD controls (4 of 51 [8%] [P = .03]). The difference was still significant after the exclusion of the AD patients' close contacts who also had AD (24% vs 8% [P = .03]). By multivariate analysis, only skin colonization of S aureus was independently associated with severe AD (odds ratio, 17.0; 95% confidence interval, 1.60-181.1 [P = .02]). CONCLUSIONS: Anterior nares of close contacts of AD patients are reservoirs of S aureus. The presence of S aureus carriers among close contacts does not predict AD severity. Skin colonization is associated with severe AD.

Measurement of pruritus in a Chinese woman with pemphigoid gestationis using a wrist movement detector.

Pemphigoid gestationis (PG) is a rare itching bullous disease of pregnancy and the postpartum period. We describe the use of a new methodology for measuring the nature and intensity of itching in a 21-year-old woman with pemphigoid gestationis. At 19 weeks gestation, she developed an itchy rash over the limbs, which spread to the trunk. Blisters then appeared on the hands which subsequently also involved the feet. Intense nocturnal wrist activities in this patient, measured with a wrist monitor and defined as average acceleration in the early hours of sleep, were even higher than that in patients with severe eczema, with an average value of 181.00 +/- 43.49 (mean +/- standard error) g/min for the first three hours, versus 84.47 +/- 8.53 g/min for the group of 24 eczema subjects. Most wrist activities were slower movements at 0 to 1 Hz. This is in striking contrast to the scratching activities at 0 to 3 Hz in eczema subjects. There have been no therapeutic trials for PG. Topical steroid and oral antihistamines are usually ineffective, but worked in our patient. We also discuss the potential application of the monitor in assessing the nature of various dermatological or systemic itching disorders.