Skin Barrier Function and Staphylococcus aureus Colonization in Vestibulum Nasi and Fauces in Healthy Infants and Infants with Eczema: A Population-Based Cohort Study.

Leif Bjarte Rolfsjord,Teresa Løvold Berents,Maria Bradley,Peter Gaustad,Bente Kvenshagen,Håvard Ove Skjerven,Agne Lieden,Petter Gjersvik,Karin Cecilie Lødrup Carlsen,Petter Mowinckel,Johanna M Brandner,Kai-Håkon Carlsen

doi:10.1371/journal.pone.0130145

Abstract

Atopic eczema (AE) is associated with Staphylococcus aureus (S. aureus) colonization and skin barrier dysfunction, often measured by increased transepidermal water loss (TEWL). In the present study, the primary aim was to see whether S. aureus colonization in the vestibulum nasi and/or fauces was associated with increased TEWL in infants with healthy skin and infants with eczema. Secondarily, we aimed to investigate whether TEWL measurements on non-lesional skin on the lateral upper arm is equivalent to volar forearm in infants. In 167 of 240 infants, recruited from the general population, TEWL measurements on the lateral upper arm and volar forearm, using a DermaLab USB, fulfilled our environmental requirements. The mean of three TEWL measurements from each site was used for analysis. The infants were diagnosed with no eczema (n = 110), possible AE (n = 28) or AE (n = 29). DNA samples were analysed for mutations in the filaggrin gene (FLG). Bacterial cultures were reported positive with the identification of at least one culture with S. aureus from vestibulum nasi and/or fauces. S. aureus colonization, found in 89 infants (53%), was not associated with increased TEWL (i.e. TEWL in the upper quartile), neither on the lateral upper arm or volar forearm (p = 0.08 and p = 0.98, respectively), nor with AE (p = 0.10) or FLG mutation (p = 0.17). TEWL was significantly higher on both measuring sites in infants with AE compared to infants with possible AE and no eczema. FLG mutation was significantly associated with increased TEWL, with a 47% difference in TEWL. We conclude that S. aureus in vestibulum nasi and/or fauces was not associated with TEWL, whereas TEWL measurements on the lateral upper arm and volar forearm appear equally appropriate in infants.

Highlights

Atopic eczema (AE) is a common skin disease and is characterized by dry skin, pruritus, and eczematous skin [1,2]
The main objective of the present study was to investigate if S. aureus colonization in vestibulum nasi and/or fauces, potentially preceding AE, is associated with skin barrier dysfunction as assessed by transepidermal water loss (TEWL) measurements in infants recruited from a general population
The S. aureus colonization rates in vestibulum nasi and fauces were non-significantly higher in infants with AE compared to infants with possible AE and no eczema

Summary

Introduction

Atopic eczema (AE) is a common skin disease and is characterized by dry skin, pruritus, and eczematous skin [1,2]. The pathogenesis of AE is complex, involving skin barrier dysfunction, immune dysregulation, cutaneous inflammation and colonization with Staphylococcus aureus (S. aureus) [1,8,9,10]. Dysfunction of the skin barrier leads to increased water loss and increased entry of allergens, toxins, and infectious microorganisms [1]. Skin barrier function can be evaluated by measuring transepidermal water loss (TEWL) [11]. Increased TEWL, indicating a skin barrier dysfunction, is often found in patients with AE [12,13], but has been reported in infants with dry skin and mutation in the gene encoding for the profilaggrin protein [14]. Filaggrin deficiency is a major predisposing factor for AE [15] and may be an independent increased risk factor for S. aureus colonization [16]

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