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Staphylococcal toxins in patients with psoriasis, atopic dermatitis, and erythroderma, and in healthy control subjects

https://doi.org/10.1016/j.jaad.2005.02.034Get rights and content

Background

The aggravating role of Staphylococcus aureus superantigens is well known in atopic dermatitis (AD) but has not yet been proven in psoriasis (PS).

Objective

We investigated the distribution of S aureus in the skin and nares of patients with AD, PS vulgaris, erythroderma, skin infections, and sepsis, and in healthy control subjects. A Staphylococcal enterotoxin test–reversed passive latex agglutination (SET-RPLAR) test was performed to determine Staphylococcal enterotoxins A, B, C, and D.

Results

S aureus was cultivated from lesional skin of 22 of 25 patients with AD and 15 of 25 patients with PS. Isolated strains were toxigenic in 44% for patients with AD and in 36% for patients with PS. The activity of disease in AD and PS according to the Severity Scoring of Atopic Dermatitis (SCORAD) or Psoriasis Area and Severity Index score, respectively, correlated significantly (P = .001) with an isolated toxigenic strain in both diseases. S aureus from skin infections was toxigenic in half of the patients. All patients with erythroderma harbored S aureus, mostly on their skin. In AD, sepsis and skin infections, toxin C and in PS toxin B was most often detected. S aureus was cultured in 12% of healthy persons. These strains were toxin negative. The limitations of these investigations are that other potentially acting enterotoxins, such as toxic shock syndrome toxin-1, which may play a role in aggravating disease, were not investigated with our latex agglutination test.

Conclusion

In this study, S aureus was present in more than 50% of patients with AD and PS. We found that the severity of AD and PS significantly correlated to enterotoxin production of the isolated S aureus strains.

Section snippets

Patients

To investigate skin colonization with S aureus and its enterotoxin profile, we performed a prospective study in 25 patients with AD, 25 with PS, 6 with erythroderma, and in 25 healthy control subjects between January 2001 and March 2002 (Table I). For control purposes, S aureus strains isolated from 25 patients with skin infections and 9 patients with staphylococcal sepsis were investigated. Patients with S aureus skin infection had impetigo (n = 5), leg ulcer (n = 4), basal cell carcinoma (n = 3),

Results

S aureus was cultivated from lesional skin of 22 of 25 patients with AD and 15 of 25 patients with PS (Table I). Isolated strains were toxigenic in 44% for patient with AD and in 36% for patients with PS. The activity of disease in AD and PS according to the SCORAD or Psoriasis Area and Severity Index score, respectively, correlated significantly with an isolated toxigenic strain in both diseases (Fig 1, Fig 2). S aureus was further isolated in all 6 patients with erythroderma and in 2 of 25

S aureus in PS

When we analyzed the distribution of staphylococcal enterotoxins and their potential effect on disease activity, we found colonization of lesional skin with S aureus occurred in 60% of patients with PS, consistent with data that have already been reported in the literature.4, 17 In 60%, these strains were toxigenic. The toxin most often detected was SEB followed by SEC, SED, SEA/D, and SEB/C. Patients with enterotoxin-positive PS had a significantly (P = .001) higher Psoriasis Area and Severity

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  • Cited by (142)

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    Funding sources: None.

    Conflicts of interest: None identified.

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