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Atopic dermatitis, or AD, stands as the most prevalent form of eczema, affecting over 43 million children and approximately 223 million adults globally. This chronic condition manifests intermittently throughout one’s lifetime. In individuals with AD, the immune system becomes overly reactive, inciting inflammation that compromises the skin’s integrity, rendering it dry and prone to itching and eruptions. The precise etiology of the ailment remains largely undetermined.
Exploring the Research
To ascertain the potential association between Group B Streptococcus (GBS), or Streptococcus agalactiae, and atopic dermatitis (AD) in pregnant women, researchers from the University of Pennsylvania conducted a cross-sectional study. They utilized a randomized sample from the Optum database, encompassing women who underwent vaginal deliveries between May 2007 and September 2021.
GBS reporting in a large administrative database represents a unique opportunity to conduct a population-based evaluation of GBS carriage with AD. Understanding this association could expand our understanding of microbial changes associated with AD
Corresponding author David J. Margolis, MD, PhD, of the department of dermatology at the University of Pennsylvania, Philadelphia, and his colleagues
From the database, a cohort of 566,467 pregnant women with an average age of 38.8 years was selected. Among them, 2.9% had a history of diagnosed atopic dermatitis or AD history, and 24.9% exhibited asthma, seasonal allergies, or both. In women with AD, there was an elevated odds ratio for asthma, seasonal allergies, or both, in comparison to those without AD.
The Connection Between Atopic Dermatitis and Elevated GBS Colonization Risk
Group B Streptococcus (GBS) was identified in 20.6% of women. The average observation period for patients with and without GBS was 494 days and 468 days, respectively. Among women with atopic dermatitis, 24.1% harbored GBS, compared to 20.51% of women without AD.
It is not apparent why pregnant females with AD are more likely to specifically carry GBS. However, several studies have shown that individuals with AD are more likely to carry [Staphylococcus] aureus and that individuals with AD might be deficient in host defenses against S. aureus and other pathogens
Study authors
According to researchers, individuals with atopic dermatitis often receive antibiotics as part of their treatment, potentially altering their resident microbiome. Tolerance may increase by inhibiting a crucial barrier protein known as filaggrin. Its loss of function is known to diminish barrier proteins, which are believed to suppress colonization of S. aureus and other pathogens.
The researchers acknowledged certain limitations in their study, including its reliance on administrative database records that lack information about past illnesses.
Application of Research Findings
According to Professor Adam Friedman, who was not involved in the study, numerous questions still need answers. Specifically, whether protocols for early pregnancy decolonization procedures will be employed for patients with AD remains uncertain.
Will this change practices? Pregnant women should be screened for GBS regardless, but maybe more attention or counseling can be offered to AD patients about the importance of screening.
Adam Friedman, MD, professor and chair of dermatology at George Washington University, Washington
