Results 1 to 4 of 4

Thread: Staphylococcus epidermidis: A possible role in the pustules of rosacea

  1. #1
    Senior Member
    Join Date
    Aug 2005
    Location
    Germany
    Posts
    451
    Country: Germany

    Default Staphylococcus epidermidis: A possible role in the pustules of rosacea

    This seems to be an older article, maybe it has been posted already, but I think it is interessting.


    http://www.eblue.org/article/S0190-9...317-2/abstract

    Journal of the American Academy of Dermatology
    Volume 64, Issue 1 , Pages 49-52, January 2011Staphylococcus epidermidis: A possible role in the pustules of rosacea

    Presented in part at the Australasian College of Dermatologists annual meeting in poster format in May 2007 and in oral presentations at the Australasian Society of Dermatologic Research in Sydney in May 2008 and at the Australasian College of Dermatologists Annual Scientific Meeting in Coolangatta in Sydney in May 2009. It will also be presented again in poster format at the Australasian Society of Infectious Diseases Annual Meeting in Darwin Australia in May 2010. The abstracts have been published in the Journal of Investigative Dermatology and the Australasian Journal of Dermatology.


    Accepted 16 December 2009. published online 13 October 2010.


    Article Outline



    Background

    Rosacea is a common skin and ocular disease. Cutaneous rosacea is characterized by facial flushing, telangiectasia, papules, and pustules. It is generally regarded as inflammatory in nature. We believed that the role of bacteria as a contributory factor in pustular and ocular rosacea needed to be revisited.
    Objectives

    We sought to ascertain whether there is an increase in the bacteria isolated from the (1) pustules of rosacea; and (2) eyelid margins of persons with cutaneous pustular rosacea.
    Methods

    Bacterial swabs were taken and cultured from an incised rosacea pustule, the ipsilateral cheek skin, and the eyelid margin of 15 patients with pustular rosacea. Swabs were also taken from the cheek skin and ipsilateral eyelid margin of 15 matched control subjects.
    Results

    A pure growth of Staphylococcus epidermidis was isolated from a pustule of 9 of 15 patients with pustular rosacea, and no pure growth of S epidermidis was isolated from their ipsilateral cheek skin. This was a highly statistically significant increase (P = .0003). A pure growth of S epidermidis was isolated from the eyelid margins of 4 of 15 patients with pustular rosacea, and no pure growth was isolated from the eyelids of age- and sex-matched control subjects. This was a statistically significant increase (P = .05).
    Limitations

    This study focuses on the microbial basis of rosacea.
    Conclusion

    Our findings suggest S epidermidis may play a role in pustular and ocular rosacea.
    Key words: blepharitis, coagulase-negative staphylococcus, flushing, ocular rosacea, pathogenesis, pustule, rosacea, Staphylococcus epidermidis

    Capsule Summary
    Rosacea is a common skin disease, estimated to affect 45 million people worldwide. It is classified into erythematotelangiectatic, papulopustular, phymatous, and ocular subtypes. Although separate, they are not necessarily progressive stages and are not mutually exclusive.1, 2, 3 It is generally regarded as inflammatory in nature, although the precise origin and pathogenesis remains an enigma to this day.A possible bacterial cause for rosacea was explored by Marks4 in 1968, who found that no specific pathogenic organism was identified; however, commensal organisms were isolated but dismissed. Since that time a pathogenic role for many nonpathogenic organisms has been identified, including Propionibacterium acnes,5 Staphylococcus lugdunensis,6 and S epidermidis.7
    In rosacea the blood flow is increased to the skin of the face8 and this leads to the clinical increase in temperature that is noted in persons with rosacea.9 It is known that some bacteria including S epidermidis behave differently at slightly increased temperatures.9
    This higher cutaneous temperature and continued flushing may be the environmental stimulus required for a commensal bacterium to become pathogenic.
    Back to Article Outline
    Methods

    Our aim was to assess whether there was an increase in bacteria isolated from the pustules and eyelid margins of patients with rosacea to ascertain their potential relevance. After institutional review board approval, 15 patients with rosacea and 15 age- (±5 years) and sex-matched control subjects aged 18 to 70 years (±5 years) participated in the trial.
    Study subjects and control participants were excluded if they had any other facial skin disorders such as atopic dermatitis or psoriasis.
    Patients with rosacea were identified based on history and examination and were assessed using the Clinician Global Severity Score for rosacea.2 They demonstrated persistent erythema, telangiectasia, and at least one pustule located on the convexity of the face. Participants were excluded if they had received topical or systemic antibiotic treatment 14 days before the day of assessment.
    For the study subjects with rosacea, cultures were taken from 3 sites. The first was from a visually apparent pustule, all of which were on the cheek. The skin over the pustules was cleansed with a 70% alcohol swab and incised with a sterile scalpel blade, and purulent material was gently extruded on to a sterile transport swab, containing Copan Amies Agar gel (Lomb Scientific Pty Ltd, Taren Point, Australia).
    A second swab was taken by running a sterile transport swab along the inferior eyelid margin on the same side as the pustule, and a third swab was taken by wiping a similar swab over the cheek at least 2 cm away from the pustule on the same side, without the skin being cleansed.
    Swabs were taken to the laboratory, streaked on to chocolate and brain heart infusion agar plates, then cultured aerobically and anaerobically at 37°C for 48 to 72 hours. For the control participants a swab was taken from the central cheek without cleansing the skin and a swab was also taken from the inferior eyelid margin from the same side. Swabs were streaked and cultured as previously described.
    After incubation, standard morphologic tests were used to identify bacterial organisms to differentiate staphylococci, micrococci, and related genera. If a pure growth of a coagulase-negative staphylococci was confirmed, species identification was performed using the API STAPH identification kit (bioMerieux, Marcy l'Etoile, France).
    Testing for beta-hemolysis was performed on Columbia Blood Agar Base (BD, North Ryde, Australia).
    Once species identification was completed, standardized antibiotic susceptibility tests were performed.10
    Back to Article Outline
    Results

    Fifteen participants with rosacea and 15 age- (±5 years) and sex-matched control participants were entered into the study. Nine (60%) subjects were female and 6 (40%) were male. Statistics were calculated using Fisher exact test for small sample sizes and a 1-tailed analysis looking for an increase in pure growth cultures from the pustules and eyelid margins of people with rosacea.
    Results of cultures from pustules of 15 patients with rosacea showed that 9 (60%) grew pure growths of S epidermidis and 6 (40%) grew either a mixed growth (2) or no growth (4). Swabs taken from the surrounding nonpustular skin of patients with rosacea showed that all 15 (100%) produced either a mixed growth (11) or no growth (4). There was a highly significant increase in the likelihood of finding pure growths of S epidermidis in the pustules than from the swabs of the surrounding skin (P = .0003).
    Results of the eyelid swabs of the rosacea group yielded 4 (27%) patients growing pure growths of S epidermidis and 11 (73%) showing either a mixed growth (8) or no growth (3). For the control subject eyelid swabs, all 15 (100%) showed either a mixed growth (11) or no growth (4). There was a statistically significant increase in the pure growths of S epidermidis isolated from the eyelid margins of the participants with clinically diagnosed cutaneous rosacea when compared with the age- and sex-matched control subjects (P = .05).
    All 4 cases in which a pure growth of S epidermidis was obtained from the inferior eyelid margin also had S epidermidis isolated as a pure growth from pustules (Table I).
    Table I. Location and type of growth of bacteria from 15 patients and 15 control participants

    Rosacea pustule 4 2 6 9
    Surrounding skin near rosacea pustule 4 11 15 0
    Eyelid margins of patients with rosacea 3 8 11 4
    Eyelid margins of control subjects 4 11 15 0




    Using Fisher exact test and 1-tailed analysis, there was significant increase in isolation of pure growth of S epidermidis from: (1) pustules of people with rosacea, when compared with pure growth of S epidermidis isolated from surrounding skin (P = .0003); and (2) eyelid margins of people with cutaneous rosacea when compared with eyelid margins of control participants (P = .05).



    When comparing cheek swabs of people with rosacea with cheek swabs of people without rosacea, 11 (73%) participants cultured mixed growths and 4 (27%) had no growth. For the control subjects, 13 (87%) had mixed growths and two (13%) had no growth. A pure growth of S epidermidis was not found in either group.
    For the mixed growth skin swabs, organisms were identified and demonstrated the presence of typical commensal flora, which included micrococci, diphtheroids, Staphylococcus, and Propionibacterium. There was no significant difference in any of these results.
    Antibiotic sensitivities were then performed on the 9 cases with pure growths of S epidermidis. All 9 (100%) were sensitive to cefoxitin, 9 (100%) to cephalexin, 8 (89%) to erythromycin, 8 (89%) to tetracycline, and 9 (100%) to gentamycin and vancomycin, but only one (11%) was sensitive to penicillin.
    Back to Article Outline
    Discussion

    This study differs from other studies looking at the role of bacteria in a pathologic processes by using the patients' own skin as the control. It has demonstrated a highly statistically significant (P = .0003) increase in the pure growth of a bacteria, namely S epidermidis (usually regarded as a commensal) from a pustule when it is compared with the mixed bacterial growth found from the skin adjacent to the same pustule. It is noteworthy that we did not find a pure growth of any other bacteria. This result suggests that S epidermidis is likely to be an integral part of the disease process in pustular rosacea and may play a role in ocular rosacea.
    Dahl et al9 also isolated S epidermidis from the rosacea pustules of all 4 of his reported patients with rosacea, although the possible role of this bacteria in rosacea has not been further reported. He did, however, note that the bacteria he cultured produced different proteins when cultured at different temperatures.
    Although these data suggest that S epidermidis might have a role in the formation of the pustules, we cannot rule out that the substrate cutaneous environment in the pustules of patients with rosacea favors the growth of S epidermidis.
    Doxycycline is thought to act in rosacea mainly via its anti-inflammatory action.10 This research has shown that S epidermidis may play a role in pustular and ocular rosacea, therefore examining the antibiotic sensitivities of this organism may help us to understand why other antibiotics may also be effective in some cases.
    The temperature of the skin is known to be increased in persons with rosacea.9 It is likely that this is the result of the long history of flushing and the development of altered dermal vasculature, which increases blood flow to areas affected by rosacea.8, 11 Increased temperature of the face has been shown to occur in settings of both exercise12 and consumption of hot drinks13 and alcohol.14 As pustules do not precede the erythematous change, we believe this increase in vascularity and the temperature of the skin may represent an important step in stimulating the usually commensal organism S epidermidis to behave as a pathogenic organism, leading to development of papulopustular rosacea.
    Back to Article Outline
    Conclusion

    Further study is warranted to explore the significance of the role of S epidermidis in papulopustular rosacea and ocular rosacea.
    Back to Article Outline
    We thank the estates of Mrs Dorothy Crane and Albert W. Johnston and the Australasian College of Dermatologists Scientific Research Fund for helping to fund this research. We thank the St Vincent's Hospital microbiology laboratory staff including Associate Professor Jock Harkness, Ms Sanna Hawkins, and Emeritus Professors Adrian Lee and Ross Barnetson and Associate Professors Pablo Fernandez-Penas and Steven Kossard for their support.
    Back to Article Outline

  2. #2
    Senior Member johnabetts's Avatar
    Join Date
    Sep 2012
    Location
    England
    Posts
    1,129
    Country: UK

    Default

    Thanks to the new indexing this very interesting item has come to the top.

    Great!!

  3. #3
    Senior Member Starlite's Avatar
    Join Date
    Dec 2012
    Posts
    1,348
    Country: United States

    Default

    I agree John, it's an awesome article.

    I have some questions about this study. I wish they would have checked to see if the S epidermidis was found on other parts of the body in higher numbers for the rosacea patients too. I also would have liked to know if it was found in conjunction with demotix mites. The study said that S epidermidis is usually a commensal organism, ( These normally harmless bacteria are referred to as commensal bacteria. Commensal bacteria help keep our bodies healthy in many ways: they help us to digest foods and acquire nutrients such as vitamins B and K, encourage your immune system to develop and prevent the colonization of bacterial pathogens that cause disease by competing with them. ) so I worry that their recommendation of systemic antibiotics will cause a cascade of flora and fauna imbalances that we all know can lead to a whole host of health problems.

  4. #4
    Moderator man_from_mars's Avatar
    Join Date
    Apr 2008
    Location
    4th rock from the Sun
    Posts
    1,370
    Country: United States

    Default

    Quote Originally Posted by johnabetts View Post
    Thanks to the new indexing this very interesting item has come to the top.

    Great!!
    It's actually a manual thing - moved whatever posts I could find dealing specifically with Type 1,Type 2 or Type 3 into the new forum sections.
    So if you come across any others let me know.

    mfm

Similar Threads

  1. Can rosacea pustules be squeezed like normal pustules?
    By raly in forum General rosacea questions
    Replies: 4
    Last Post: 30th March 2018, 04:47 PM
  2. The role diet plays in rosacea
    By Brady Barrows in forum News, research articles and current affairs
    Replies: 5
    Last Post: 1st September 2007, 04:05 PM
  3. Role that diet may play in the etiology of rosacea
    By Brady Barrows in forum News, research articles and current affairs
    Replies: 3
    Last Post: 8th February 2007, 09:55 AM
  4. Does the role diet has in acne similar in rosacea?
    By Brady Barrows in forum General rosacea questions
    Replies: 1
    Last Post: 11th July 2006, 10:50 PM
  5. What is the role of fibroblasts in rosacea?
    By IowaDavid in forum General rosacea questions
    Replies: 0
    Last Post: 20th November 2005, 03:52 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •