Topical Corticosteroids Effective for Staphylococcus aureus in Hand Eczema

Topical corticosteroids (TCS) treatment is associated with a significant decrease in Staphylococcus aureus colonization in patients with hand eczema (HE), investigators reported in a study published in the Journal of the European Academy of Dermatology and Venereology.

Researchers assessed the density of S. aureus in patients with HE who received TCS treatment after 2 weeks of follow-up. Participants were enrolled from December 2019 to March 2021 from 2 dermatologic outpatient clinics in Denmark.

Eligible participants were aged 18 years of age and older and had moderate to severe disease corresponding with HE severity index (HECSI) score 17 or higher, a dermatologist-prescribed potent TCS (class III-IV) applied once daily, no TCS treatment 1 week before inclusion, no antibiotic or ultraviolet therapy within 1 month before inclusion or during the study, and no pregnancy or breastfeeding. The patients were instructed not to use alcohol-based hand rub on the days they were evaluated.

The study authors collected 2 bacterial samples at baseline from participants’ most severe lesional and nonlesional skin, as well as at the 2-week follow-up visit. The investigators used 50 µL of the swab transportation medium on S. aureus–selective plates followed with incubation at 37°C for 20 to 24 hours.

The relative change in colony forming units (CFU) before and after TCS was assessed with use of paired t-test of log10-transformed CFU values. P values < .05 were considered statistically significant.

A total of 35 patients were included with baseline visits, and 31 patients (mean [SD] age 44.6 [14.3] years; 58% women) were included in the paired analysis. HE severity improved significantly after 2 weeks of treatment.

Colonization with S. aureus was identified on the lesional skin in 63% of patients at visit 1 and was associated with higher HECSI compared with patients without S. aureus colonization (P = .004, Wilcoxon, unpaired). At visit 2, 35% of patients were culture-positive, 2 of whom were culture-negative at the first visit.

Patients had an overall relative decrease of S. aureus CFU on lesional skin with a log10 (after/before) ratio of –1.791 (P = .002, t-test, paired). The relative decrease in HECSI was not significantly associated with the corresponding decrease in S. aureus CFU on lesional skin (P = .155). The number of patients who had reduced density of S. aureus between visits was evenly distributed among different subtypes of HE.

The researchers noted that swabs for assessing S. aureus density have limitations, including the accuracy of sampling consistency. Also, the limited wash-out period of TCS before inclusion and use of hand hygiene as usual may have affected the findings.

“Collectively, we found a decreasing density of S. aureus on the hands of HE patients following short-term treatment with TCS along with improvement in HE severity,” the researchers stated.

Disclosure: Several of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Nørreslet LB, Edslev SM, Bregnhøj A, et al. Topical corticosteroids reduce the density of Staphylococcus aureus in hand eczema. J Eur Acad Dermatol Venereol. Published online November 29, 2021. doi:10.1111/jdv.17844