Staph Bacteria Series with Dr. Clay Cockerell: Understanding Staph Bacteria on Eczema Skin

Dr. Clay Cockerell – Board-certified Dermatologist and Dermatopathologist

This is a 4-week series focused on bacteria found on our skin, in particular Staphylococcus aureus, a bacterium that can lead to infection and complications in eczema patients. I’m honored to have Dr. Clay Cockerell, the clinical professor of dermatology and pathology and the director of the Division of Dermatopatholgy at University of Texas Southwestern Medical Center in Dallas, Texas, to help in this series.

More on Dr. Cockerell – Dr. Clay Cockerell was the president of the American Academy of Dermatology in 2005. He is a renowned medical educator having overseen an educational program designed to train the next generation of dermatologists and dermatopathologists and the author of numerous papers and textbooks. He is a board-certified dermatologist and dermatopathologist licensed in many states throughout the U.S. His clinical expertise is in skin disorders and his passion has led him to co-found TopMD Skin Care, the company behind CLn® BodyWash.

Staph and Other Harmful Bacteria

Last week, Dr. Clay Cockerell gave us some basics about the type of bacteria found on our skin. This week, we will discuss Staphylococcus aureus (“Staph”) and other harmful bacteria.

Staph aureus is not normally found on our skin, but in some people such as those who are colonized, it may be. When it is, it tends to involve areas that are warm and moist especially such as skin near mucous membranes such as the nose, mouth, genitals and anal area. It is found in about 25-30% of healthy adults who are known as carriers and generally does not cause an infection in those with otherwise healthy skin. It is a very resistant bacterium and it can survive in dry conditions such as on dry skin and with little oxygen.

Marcie Mom: Dr. Clay, I understand that Staph is a main factor causing skin inflammation in eczema skin. Can you detail for us where Staph bacteria reside, how it penetrates and attacks the (i) skin and (ii) body of our child with eczema?

Dr. Clay:  As noted in the first post of this series, Staph likes warm, moist, dark areas like the nose and groin, which are known as “reservoir” sites where it resides. In patients with eczema, it can affect any area of the skin that is compromised or affected with the dermatitis. Because the skin is compromised, it does not have a normal barrier, and the immune response is abnormal. The Staph grows in the skin and releases toxins that cause inflammation, which further worsens the eczema. It can begin growing in the skin and establish infection in the form of boils, cellulitis and folliculitis (“pus bumps”) in these individuals, as well. Rarely, it can actually enter the lymph and blood vessels and spread throughout the body, but it tends to remain localized at the site of entry.

Marcie Mom: Another harmful one is the streptococcus pyogenes bacteria (“strep”), found in our throat and skin and in about 20% of healthy adults. Staph or strep bacteria can lead to skin infections such as folliculitis, furunculosis, impetigo, cellulitis, MRSA and Staphylococcal scalded skin syndrome (read more here). A skin culture can be performed which will diagnose which bacteria is present on the skin.

Marcie Mom: There are various symptoms of bacterial skin infection listed below, can you share with us the severity of the infection, e.g. when a parent ought to (i) seek a general practitioner’s consultation or (ii) rush to emergency?

Dr. Clay:

Symptoms – itchy red rashes. This is the most common manifestation of eczema and may or may not be infected with bacteria. This can be treated at home using the prescribed treatment regimen.

Symptoms – skin turns painful, warm to touch/tenderness, swelling. This is a sign of a skin infection and needs to be seen by a doctor soon. If there is fever, this is something that a doctor should be notified about and an oral antibiotic should be started. It probably does not require a visit to an emergency room, but it should be called to the attention of a doctor who would evaluate the severity and might recommend that the patient be seen. These infections can arise at any time during the course of the disease.

Symptoms – infected area is filled with pus/blister/boil. As above, this is a sign of an infection and should be treated with an antibiotic. These are usually localized, but may require drainage. A caregiver should be notified who will prescribe a regimen such as applying warm compresses, topical antibiotics and possibly oral antibiotics. Generally, the patient should be seen soon and a culture performed. This is not usually an emergency, but if there is fever or redness that is spreading like above, it might require more urgent attention than a follow-up in a clinic.

Symptoms – lymph node on neck or armpit becomes protruding/ sore. This is also another sign of infection and would generally be treated like cellulitis. This is not usually an emergency, but would require antibiotics and culture.

Symptoms – fever/ chills, low blood pressure. This is a sign of a serious systemic infection, and the patient should be taken to an emergency room by an ambulance.  This could be a manifestation of Toxic Shock Syndrome, which can be caused by some forms of Staph, or could possibly be necrotizing fasciitis, which might need emergency surgery.

MarcieMom: Thank you Dr Cockerell for helping us understand which symptoms we ought to be aware of. Next week, we will explore the treatment options and learn more about MRSA.

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