THE ROLE OF ANTIBACTERIAL THERAPY IN THE TREATMENT OF ATOPIC DERMATITIS IN CHILDREN

Abstract

Background. Atopic dermatitis is one of the most common chronic inflammatory skin diseases. In atopic dermatitis, the diversity of the normal microflora decreases, so that the number of S. aureus prevails and the number of bacteria with antistaphylococcal activity decreases. The aim of this study was to evaluate the effectiveness of mupirocin 2% cream in the treatment of atopic dermatitis in children as an additional therapy, and the effect of the rs4696480 polymorphism in the TLR2 gene on the effectiveness of the treatment. Materials and methods. The study included patients with atopic dermatitis (n = 37), aged 1-18 years (7.9±4.9) from the Department of Allergy at Kyiv City Children Clinical Hospital №2. All children included in the study with atopic dermatitis had a positive S. aureus culture. Patients were randomized into two groups: a group receiving mupirocin 2% cream on the affected skin areas 2 times a day 10 days (group A) and a control group (group B). Children of the control group received only symptomatic therapy. The SCORAD score and CDLQI (children's dermatology life quality index) questionnaire score was recorded before and after the treatment, side effects were recorded during the study. Skin swab cultures were taken before and after treatment. Genotyping for TLR2 rs4696480 was performed by using Real-time PCR. This study was approved by the ethical committee of the O.Bogomolets National Medical University; all patients/ parents of the children gave an informed consent to participate. Statistical processing of the obtained data was carried out using the statistical package IBM SPSS Statistics Base (version 22) and the software EZR version 1.32 (graphical interface of the R environment (version 2.13.0). The difference in the effectiveness of therapy between the two subgroups and the influence of genotype on the effectiveness of therapy was determined using the Student criterion for parametric data (T) and Wilcoxon W-test for nonparametric data (W). The dynamics of indicators in each group before and after treatment were evaluated using the Wilcoxon T-test (T-W). Eeffectiveness of S. aureus eradication was estimated using the odds ratio (OR) with a 95% confidence interval (CI). Results were considered statistically significant at the level of p < 0.05. Results. In both groups of children, improvement was observed in 10 days after the treatment. In group A, the improvement in ΔSCORAD was found to be 13.8 (T-W=190.0, p<0.001). In group B, there was also an improvement: ΔSCORAD 8.5 (T-W=153.0, p<0.001). The difference in ΔSCORAD scores between groups A and B was statistically significant (T=2.70, p=0.011). The decrease in CDLQI score after treatment was 31.3% in group A (T-W=190.0, p<0.001), and 18.3% in group B (T-W=171.0, p<0.001). The difference between these two groups was not statistically significant (W=334.0, p=0.409). After the treatment, the skin culture showed that in group A, 57.9% of patients were S. aureus-negative, in group B, only 22.2% of children had a negative culture (OR= 5.50, CI 1.32-22.86). We compared ΔSCORAD depending on the genotype of the rs4696480 polymorphism in TLR2 gene and found no difference in the two subgroups: In the subgroup with the AA genotype, ΔSCORAD was found to be 12.6±3.7; in the subgroup with the TT genotype ‒ 14.4±5.1 (T=0.84, p=0.413). Conclusions. Our results demonstrate the effectiveness of the use of topical mupirocin in the treatment of atopic dermatitis as an additional therapy.

Keywords

• Mupirocin; Atopic Dermatitis; Staphylococcus Aureus; Children