Case scenario 2 How should infected atopic eczema be treated

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The relationship between Staphylococcus aureus and atopic eczema disease activity has been debated for many years. Most physicians recognise clinically infected eczema as recent onset of weeping, oozing and serous crusting or overt pus overlying the eczematous lesions. In this situation S. aureus is isolated in 90-100% of cases, usually in high numbers.1,2 In around 30% of cases, beta haemolytic streptococci are also isolated.1 Clinical infection is undoubtedly a

Figure 17.2 Infected atopic eczema major problem for some atopic eczema sufferers.3

S. aureus is also isolated from the lesions of atopic eczema in 50-90% of patients without overt signs of infection.4,5 Here, the role that S. aureus plays is much less clear. The idea that it may contribute to disease activity has led to the development of many antimicrobial compounds and their widespread use in the management of clincally non-infected atopic eczema. This section evaluates the possible benefit of these agents, primarily for clinically infected atopic eczema. Their use in clinically non-infected (colonised) eczema will also be commented on.

One systematic review was located,6 which has been the source of much of the data in this section. A total of eight RCTs evaluating the possible benefit of oral or topical antimicrobials in clinically infected eczema were located and are summarised in Table 17.6. Additional RCTs evaluating the possible benefit of antiseptics in atopic eczema are presented in Table 17.7.

QUESTIONS

How useful are systemic antibiotics?

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