Alterations in the skin microbiome are associated with disease severity and treatment in the perioral zone of the skin of infants with atopic dermatitis.

Atopic dermatitis (AD), a chronic relapsing inflammatory pruritic skin disorder with a unique pathophysiology, has a high incidence in the perioral zone among infants. This study aimed to analyze the association of skin microfloral dynamics with disease severity and treatment of AD in 0-1-year-old infants. Based on the eczema area and severity index, subjects were divided into five groups, i.e., mild, moderate, severe, and severe post-treatment, with a healthy control group, and bacterial density at the perioral lesion, disease severity, and treatment were assessed in 0-1-year-old infants with AD. The perioral lesions were colonized predominantly by Firmicutes, followed in abundance by Proteobacteria, Actinobacteria, and Bacteroidetes. In the phylum Firmicutes, Streptococcus was the most predominant genus. In AD infants, the abundance of Bacteroidetes and Fusobacterium decreased significantly with an increase in disease severity (p < 0.01). The abundance of 6 genera, including Prevotella, decreased significantly with an increase in disease severity (p < 0.05). The abundance of Prevotella melaninogenica decreased gradually with an increase in disease severity and increased after treatment; this trend was reversed for Corynebacterium simulans. A reduction in the abundance of Staphylococcus and an increase in that of skin microflora including Prevotella spp., Staphylococcus epidermidis, and Erwinia dispersa were associated with treatment and clinical improvement. Skin bacterial composition varies with AD severity, and Corynebacterium simulans and Prevotella melaninogenica are positively and negatively correlated with AD severity, respectively. This study provides a theoretical basis to identify potential biomarkers AD occurrence and pathogenesis.

[Staphylococcal Scalded Skin Syndrome in a Very Low Birth Weight Premature Infant]. / Staphylococcal Scalded Skin Syndrome bei einem sehr unreifen Frühgeborenen.

INTRODUCTION: Staphylococcal scalded skin syndrome (SSSS) was often endemic in the past but is nowadays rare. The hematogeneous spread of exfoliative toxins A (ETA) or B (ETB) produced by specific Staphylococcus aureus strains causes a scald-like eruption with disseminated bullous lesions. CASE REPORT: A perioral impetigo lesion occurred on day 14 of life in a preterm male infant (1,065 g, 30 weeks of gestational age). Empiric antibiotic therapy with cefotaxime and vancomycin was given for 6 days and led to complete resolution. A Staphylococcus aureus strain was isolated. After a symptom-free interval a relapse was noted on day 26 of life. Despite restarting the antibiotic therapy immediately the initial lesion expanded, and disseminated flaccid blisters on an erythematous base appeared within a few hours. On histological examination the cleavage was in the level of the granular layer. There was no mucosal involvement, and the Nikolsky I sign was positive. The antibiotic therapy was changed to a combination of cefotaxime, flucloxacillin and clindamycin which rapidly stopped progression of the exfoliation. Supportive therapy included adequate analgesia, parenteral rehydration, and application of local antiseptics. The preterm infant completely recovered. In the primary lesion an ETA-producing Staphylococcus aureus strain was isolated. Nasal microtrauma by a nasogastric tube was assumed to have caused the fulminant disease. At the same time, no other Staphylococcus aureus infections were seen in our Department of Neonatology. DISCUSSION: According to the literature, the incidence of SSSS is higher in premature infants and newborns than in older children. Possible causes include lower antibody levels against exfoliative toxins and renal immaturity. Rapid diagnosis and immediate appropriate antibiotic therapy are essential to prevent secondary infection, dehydration with electrolyte disturbance, death, and endemic spread.

The pathogenetic role of rod-shaped bacteria containing intracellular granules in the vellus hairs of a patient with perioral dermatitis: A comparison with perioral corticosteroid-induced rosacea.

The cause of perioral dermatitis is still unknown. We previously reported that rod-shaped bacteria (RB) containing intracellular granules were detected in cases of perioral dermatitis at a high incidence. The aim of this study was to study further the role of RB in perioral dermatitis. Altogether 10 patients with perioral dermatitis and eight patients with perioral corticosteroid-induced rosacea, who were referred to our department from 2009 to 2014, were examined for the presence of RB, using the tape-stripping toluidine blue method. RB were detected on the surfaces of the roots of vellus hairs from lesions in nine of the 10 patients with perioral dermatitis. In contrast, RB were not detected in any of the eight patients with perioral corticosteroid-induced rosacea. No RB were found in the perioral areas of other types of facial dermatitis, including atopic dermatitis and seboerrheic dermatitis or in 16 healthy controls. We treated four of the patients with perioral dermatitis with minocycline hydrochloride and five with cefcapene pivoxil hydrochloride hydrate. Three of the patients with perioral dermatitis who were treated with minocycline hydrochloride were cured in 3 to 8 weeks, while the five patients treated with cefcapene pivoxil hydrochloride hydrate were cured in 2 to 9 weeks. These results strongly suggest that RB (possible fusobacteria) play an important role in perioral dermatitis and that this is probably a distinct clinical entity from corticosteroid-induced rosacea. Cefcapene pivoxil hydrochloride hydrate seems to be an effective treatment for perioral dermatitis associated with RB.

Three cases of perioral dermatitis related to fusobacteria treated with ß-lactam antibiotics.

BACKGROUND: The oral tetracyclines, especially minocycline hydrochloride, are often used as an effective treatment for perioral dermatitis; however, they are sometimes difficult to use, especially in children, because of the side effects. OBJECTIVE: The effectiveness of ß-lactam antibiotics was evaluated in three cases of perioral dermatitis. METHODS: Three Japanese patients with perioral dermatitis were treated with cefcapene pivoxil hydrochloride hydrate per os 100-300 mg/day. They were one girl (aged 10 years) and two adult women (aged 32 and 37 years respectively). One of the adult patients had a past history of Meniere's disease and the other had had a side effect, vertigo, from minocycline hydrochloride treatment. The presence of fusobacteria before and after the treatment was examined using the tape-stripping toluidine blue method. RESULTS: These patients showed the improvement in 1-2 weeks and were much improved or cured after 2-5 weeks. No side effects were found during the treatment. Fusobacteria were positive before treatment but became negative after the treatment in all of them. CONCLUSION: The ß-lactam antibiotics might be a useful treatment for perioral dermatitis, especially in cases who cannot take tetracyclines.

Common features of periocular tinea.

OBJECTIVE: To present the common features of periocular tinea to aid physicians in future diagnosis and therapy of this condition, because superficial fungal infections on the face are often misdiagnosed owing to the diverse morphologies that they manifest. This is especially true of dermatophytoses involving the periocular region. METHODS: A retrospective review was performed of patients with a diagnosis of periocular tinea who were seen between January 2003 and September 2009 in the pediatric dermatology clinic at St. Louis Children's Hospital. RESULTS: Ten cases of periocular tinea were identified (6 male patients and 4 female patients). Common features included prolonged misdiagnosis (all 10 cases), a normal ophthalmologic examination (all 10 cases), and inappropriate corticosteroid application (7 cases). Loss of the eyelashes occurred in all 10 patients. No cases had evidence of other tinea infections on examination. Only 2 cases had the central clearing classically associated with tinea corporis. Seven patients had a potassium hydroxide preparation and/or culture positive for fungal elements. Lesions improved with topical and oral antifungal treatment in all cases, and patients were able to regrow their eyelashes. CONCLUSION: Periocular tinea should be considered in the differential diagnosis for periocular inflammation, especially in those patients refractory to therapy for more common conditions. Loss of the eyelashes is characteristic of these fungal infections, similar to the hair loss that occurs in kerions associated with tinea capitis.

Differences between intrafollicular microorganism profiles in perioral and seborrhoeic dermatitis.

Although often associated with overuse of topical corticosteroids, perioral dermatitis seems to develop seldom in patients with typical seborrhoeic dermatitis in spite of long-term application of corticosteroids. In order to compare the profiles of intrafollicular microorganisms in the lesions of perioral and seborrhoeic dermatitis, tape-stripped samples were obtained from eight lesions of perioral dermatitis, 10 lesions of seborrhoeic dermatitis, and the perioral skin of 31 normal subjects. After staining with Toluidine blue, resident microorganisms on plucked hair roots were evaluated microscopically. In all patients with perioral dermatitis and two normal subjects, 20-70% of sample hairs were positive for fusiform bacteria regarded as fusobacteria. Malassezia-positive hairs were rarely seen in these cases. Seborrhoeic dermatitis showed the opposite results. Perioral dermatitis may tend to develop under fusiform-bacteria-rich conditions, rather than Malassezia-rich conditions as in the case of seborrhoeic dermatitis.

Past administration of beta-lactam antibiotics and increase in the emergence of beta-lactamase-producing bacteria in patients with orofacial odontogenic infections.

OBJECTIVE: The purpose of this study was to determine the current status of beta-lactamase-producing bacteria in orofacial odontogenic infections. STUDY DESIGN: Microbiologic data regarding purulent exudate from 111 cases with orofacial odontogenic infections were analyzed in relation to the past administration of beta-lactams. RESULTS: beta-lactamase-producing bacteria were isolated more frequently from the beta-lactam-administered group (38.5%) than from the beta-lactam-nonadministered group (10.9%; P <.005), and they were isolated more frequently as the duration of administration increased. The predominant bacteria isolated included Prevotella (the most frequent isolate), viridans streptococci, Peptostreptococcus, and Fusobacterium, and 7.1% of total isolates produced beta-lactamase. Penicillin and cefazolin worked well with beta-lactamase-nonproducing Prevotella but were remarkably affected by beta-lactamase-producing Prevotella. Cefmetazole, sulbactam/cefoperazone, and imipenem worked well against both types of Prevotella. CONCLUSIONS: beta-lactams are still suitable for the first antimicrobial therapy in the treatment of these infections. However, because past beta-lactam administration increases the emergence of beta-lactamase-producing bacteria, beta-lactamase-stable antibiotics should be prescribed to patients with unresolved infections who have received beta-lactams.