Staph. aureus colonization
More than 75% of patients with atopic dermatitis have Staph. aureus colonization. It is significantly more likely to be MRSA than the colonization in the general population. 80% of atopic dermatitis patients are colonized with Staph. aureus, 16% with MRSA. S. aureus (enterotoxins), M sympodialis, and allergens are trigger factors of atopic dermatitis - they stimulate dendritic cells (JACI, 2012).
Bleach baths and Bactroban ointment significantly decrease symptom scores and body surface area affected by atopic dermatitis.
Dosing in bleach baths for eczema: half cup of bleach to a tub full of water. Alternatively, 2 tablespoons in a spray bottle for shower.
Intranasal mupirocin ointment and oral antibiotics may also help reduce Staph load and ensuing inflammation in eczema.
Omalizumab (Xolair) is approved for IgE levels below 700 u/ml. It is difficult to get approval in allergic skin disease, where IgE is often very high, sometimes in the thousands.
Omalizumab is being studied in atopic dermatits, but early data suggests may be more useful in acute control.
Vitamin D for atopic dermatitis: may increase production of antimicrobial peptides. However, the dose that is needed is unclear.
Foods, pets, mites and cockroaches can impact eczema control in children.
Atopic Dermatitis Treatment - Illustrated (click here for full size image).