Consensus Paper Addresses S. aureus Exacerbated AD

10/22/2024

A significant unmet need exists for a single topical atopic dermatitis (AD) therapy effective against all symptoms—including pruritis, S. aureus-driven AD exacerbation, infection, and inflammation—across AD severity levels, according to a panel of six pediatric dermatologists who participated in face-to-face discussions followed by a blinded vote to define five final consensus statements on managing S. aureus-driven AD in clinical practice.

The consensus statements were published as part of “A Consensus on Staphylococcus aureus Exacerbated Atopic Dermatitis and the Need for a Novel Treatment” in the Journal of Drugs in Dermatology. Panelists included Practical Dermatology Editorial Board members Lawrence F. Eichenfield, MD, FAAD, FAAP, and Peter Lio, MD, FAAD, along with Lawrence A. Schachner, MD, FAAD, FAAP; Anneke Andriessen, PhD; Mercedes E. Gonzalez, MD, FAAD; Karan Lal, DO, MS, FAAD; and Adelaide A. Hebert, MD, FAAD.

The panel reached a consensus on the following statements:

  • Currently, no single product is effective against all signs and symptoms of atopic dermatitis (AD), including xerosis, pruritus, infection, and S. aureus-driven AD exacerbation.
  • S. aureus almost universally colonizes the skin of AD patients, contributing to AD infections and the development of flares and exacerbations.
  • Methicillin-resistance and mupirocin resistance by S. aureus are associated with decreased skin commensal bacteria and an increased risk of secondary infection.
  • Stewardship in topical and systemic antibiotics is warranted.
  • A needed and effective treatment for AD may have the following features:
    1. Long-term safety profile enabling long-term continuous use in children down to age 2 years and preferably younger and in all anatomic areas.
    2. Effective against the bacterial component of AD, which includes effective treatment of AD with secondary bacterial infection and effective controlling the bacterial microbiome on the AD skin to attenuate AD future flares.

“Effective AD therapy should include topical treatment that restores the skin barrier, reduces S. aureus-driven secondary bacterial infection, controls inflammation and flares, including S. aureus-driven AD flares, and eliminates pruritus and xerosis,” the article concluded. “With its anti-pruritic and antibacterial properties, the emerging agent, zabalafin, may address an unmet need for a single topical therapy that treats all AD symptoms and severities in pediatric and adult patients. However, further clinical research and guideline amendments are needed to change antibiotics as first-line treatment for secondary infected AD in clinical practice. Antibiotic stewardship in secondary bacterial infection AD treatment is essential to prevent widespread and increasing antibiotic resistance. Clinician education is needed to improve knowledge of effective secondary bacterial infection AD therapy strategies and strategies for effective therapy to prevent S. aureus-driven AD exacerbation, considering the role of S. aureus, including MRSA and the skin microbiome.”

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