The antibacterial-corticosteroid combination: What is its role in atopic dermatitis?

The role of Staphylococcus aureus and therefore the place of combined antistaphylococcal and corticosteroid therapy in atopic dermatitis remains uncertain. While overt secondary infections such as furunculosis and impetigo respond rapidly to antibacterials, there is conflicting evidence as to the effect of antistaphylococcal therapy in atopic dermatitis that is not overtly infected. It is unlikely that antibacterials contribute to the management of mild atopic dermatitis. In more severe cases higher densities of S. aureus colonization are present. Antibacterials, whether topical or systemic, in combination with topical corticosteroids, may produce a more rapid decrease in S. aureus colonization than topical corticosteroids alone. Evidence for an accompanying greater speed in clinical improvement of the dermatitis is, however, mostly lacking. Topical antibacterial-corticosteroid combinations can be useful when treating small areas of skin for a limited period of time but are accompanied by the risk of sensitization and the emergence of resistant strains of bacteria. Systemic antibacterials in combination with topical corticosteroid are more appropriate when larger areas are involved.