Atopic dermatitis complicated by methicillin-resistant Staphylococcus aureus infection

Introduction: Staphylococcus aureus colonization/infection is commonly associated with disease severity in children with atopic dermatitis. The present report is a three-year retrospective chart review of five cases (comprising three boys and two girls, aged 9-15 years at referral) of methicillin-resistant S. aureus (MRSA) in children with moderate-to-severe atopic dermatitis. The review period spanned 2004-2007. All had longstanding severe disease, high IgE and eosinophil counts. Generalized erythema and a peculiar fishy odor were frequently observed by parents and physicians when MRSA was isolated during some of the episodes of exacerbation. All had tried various combinations of topical and systemic steroids, topical immunomodulants, traditional Chinese medicine and courses of antibiotics-without lasting relief. All specimens of MRSA had in-vitro sensitivity to vancomycin, with corresponding clinical correlates of disappearance of the erythema and fishy odor. Conclusion: A fishy odor and facial/generolized erythema in a patient with atopic dermatitis should alert the physician to screen for MRSA. The organism is rarely isolated, even among children with moderate-to-severe atopic dermatitis, and is usually sensitive to vancomycin.