The Journal of Dermatology | 2021
Immunoglobulin G levels against Staphylococcus aureus maintained before and after treatment of severe atopic dermatitis
Abstract
Dear Editor, The human skin microbiome plays an important role in the development of the immune system and protection from pathogens. The type of skin microbiome in patients with atopic dermatitis (AD) varies depending on the progression of AD,1– 3 and Staphylococcus aureus is prevalent in those with severe inflammation. On the other hand, abundant bacterial species are detected on the skin in those with wellcontrolled AD.1– 3 However, whether immunity against bacterial species is weakened during the severe condition has not been investigated so far. A 20yearold man with flared up AD was admitted to our department. His body was covered with dry eczematous lesions (Figure 1a,b). The laboratory findings revealed the following: white blood cells, 9560/μL (neutrophils, 52%; eosinophils, 19%); Creactive protein, 0.42 mg/dL; thymusand activationregulated chemokine, 6546 pg/mL; and immunoglobulin (Ig)E, 7568 IU/mL. S. aureus, Streptococcus dysgalactiae, and coryneform bacteria were detected by bacterial culture at the site of eczematous lesions. Treatment consisting of the strongest steroid ointment and moisturizer in conjunction with oral antihistamine was initiated, showing immediate improvement of the skin (Figure 1c,d). The microbiome on the skin is influenced by the deterioration and improvement of AD. We investigated the serum IgG titer against pathogens, including several types of bacteria and fungi, by indirect enzymelinked immunosorbent assay (ELISA) in the inflammatory stage and after stabilization of AD based on the Eczema Area and