Case Report

Dermatology Research

Research Article

Antiseptic Treatment of Povidone-Iodine Solution as a Countermeasureagainst Staphylococcus Aureus in Atopic Dermatitis
Sugimoto K1*, Hattori T2, Kitukawa Y3, Aotsuka A3, Wada T3, Kubosawa H4 and Ito S5
Departments of Clinical Allergology,
Tsudanuma, Funabashi, Japan.
1

Neurology

ClinicDepartments of Neurology, Neurology Clinic Tsudanuma,
Funabashi, Japan.
2

Departments of Internal Medicine, Chiba Aoba Municipal
Hospital, Chiba, Japan.
3

Correspondence:*

Sugimoto K, Departments of Clinical Allergology, Neurology Clinic
Tsudanuma, Funabashi, Japan, E-mail: ka.sugimoto.chiba.jp@nifty.
com.
Received: 20 July 2019; Accepted: 09 August 2019

Clinical Pathology, Chiba Aoba Municipal Hospital, Chiba,Japan.
4

Department of Neurology, Chiba University Graduate School ofMedicine, Chiba, Japan.
5

Citation: Sugimoto K, Hattori T, Kitukawa Y, et al. Antiseptic Treatment of Povidone-Iodine Solution as a Countermeasure against
Staphylococcus Aureus in Atopic Dermatitis. Dermatol Res. 2019; 1(1); 1-3.

ABSTRACT

Many patients with atopic dermatitis have not only skin but also multiple organ disorders such as intestinal tract
and cervical spine. As the cause, the involvement of a toxin (called superantigen) produced by Staphylococcus
aureus, which is detected from the skin of atopic dermatitis, is presumed. As a measure against Staphylococcus
aureus, the use of Povidone-iodine was listed as adjuvant therapy in the Japanese Guidelines for Atopic Dermatitis
Treatment 2018. In the future, we would like to treat atopic dermatitis as a superantigen disease and propose that
Povidone-iodine solution be used in combination with general treatment as a measure against Staphylococcus
aureus.

Keywords

Atopic dermatitis, Staphylococcus
Disinfectant, Povidone-iodine.

aureus,Superantigen,considered for cases where infection may be involved. It wasstated that the use of Povidone-iodine solution may be considered
as adjuvant therapy [5].

Introduction

Discussion

Also, according to the Japanese Guidelines for Atopic Dermatitis
Treatment 2018, Povidone-iodine should not be easily used
for atopic dermatitis but the use of Povidone-iodine should beIn addition, the use of Povidone-iodine is also poorly understoodPatients with atopic dermatitis have a lower ability to protect
against bacterial infections than healthy people [1-3]. Amongthem, Staphylococcus aureus easily adheres to the rash area, andStaphylococcus aureus is detected in most cases of patients withmoderate to severe atopic dermatitis. By the way, the American
Academy of Dermatology in 2014 announced that it would
recommend bleach bath therapy as a treatment option for caseswith possible involvement of infection in moderate to severe
atopic dermatitis [4].

Dermatol Res, 2019

It is known that Staphylococcus aureus is separated more frequently
in the skin of the affected part of atopic dermatitis patients thanin the skin of healthy people, and it has been considered as anexacerbating factor since ancient times [6]. In Japan, Povidoneiodine solution is often used as a disinfectant, and in some cases, its
usefulness has been reported (Figure 1 and Table 1) [7]. However,there has been no comparative test with a control so far, and its
usefulness remains empirical. The use of povidone-iodine solution
may have adverse effects such as exacerbation of dermatitis
due to irritation on the sore surface, allergic contact dermatitis,
anaphylaxis, and effects on thyroid function [8,9].

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on the basis of medical recommendations and may be considered
as adjuvant therapy for cases considered to be associated withinfection.

Figure 1: The exposure time was strictly prescribed to be 2 min for theface and 3 min or more for the rest of the body. At the end of the exposure
time, povidone-iodine is to be thoroughly rinced off. Disinfection using
povidone-iodine is done twice to 4 times a day. Afterwards, steroido
ointment or moisturizing ointment is finally applied.
1. Povidone-iodine is also a skin irritant, and after application of the skin, thepatient should not feel pain due to irritation. In other words, it is necessary toavoid the application of Povidone-iodine solution to the erosion skin and therash part which exudes skin exudates. If an overall improvement is obtainedby the application of Povidone-iodine solution, such a skin surface can also be
improved in a short period of time so that the Povidone-iodine solution can beapplied.
2. Povidone-iodine solution contains iodine, and it is necessary to minimize
the absorption of iodine from the skin. Therefore, it is necessary to protect thetime of application to the skin and to wash out Povidone iodine completely.
Moreover, since it has been found that Povidone-iodine solution can kill
Staphylococcus aureus in 5 seconds, bacteria on the surface layer can be
killed if 5 seconds or more of Povidone-iodine solution has passed. So werecommend that you apply Povidone-iodine solution to the skin and rinseaway as soon as the patient feels pain. However, experience shows that if thepatient is 5 years of age or older, the face improves in 2 minutes for a faceand non-face skin for 3 minutes for an application time, and the rash has been
improved in many cases. We think that this leads to the sterilization of deep
Staphylococcus aureus by setting the disinfection time to some extent.
3. Since the skin of the face is anatomically thin in the epithelium andsusceptible to irritation, the stock solution of Povidone-iodine is too irritating.
Therefore, for the disinfection of the skin of the face of atopic dermatitis over
5 years old, it is used by diluting the Povidone-iodine liquid 6 times. For
children under 5 years of age, it is recommended to use Povidone-iodine inconsideration of dilution depending on the degree.

Table 1: Practical notes of Staphylococcal Disinfection Skin Care Method[7] for atopic dermatitis.

By the way, Staphylococcus aureus detected in patients with atopic
dermatitis produces a high rate of toxin. The toxin promotes thesecretion of extraordinary cytokines [10]. In addition, we havealready reported that in patients with atopic dermatitis, not only
skin but also intestinal and cervical spine disorders have beenrecognized in many cases [11-18]. Moreover, it has also been
Dermatol Res, 2019

reported that in 21 cases out of 32 cases, disorders of the intestinal
tract and cervical spine were recognized simultaneously in theexamination of the same case [15-17]. In addition, it has alreadybeen reported that duodenitis and cervical spine amelioration areimproved by the treatment using Povidone-iodine solution together
with general treatment. By the way, there are also reports that
Staphylococcus aureus is involved in the onset and exacerbationin animal experiments [19]. Therefore, we have reported that thecytokine produced by Staphylococcus aureus as a cause of multiple
organ failure may be causing the failure [15].
Thus, Staphylococcus aureus control in patients with atopic
dermatitis is important, and bleach bath therapy has already been
incorporated into the treatment guidelines in the United States.
Povidone-iodine can also kill MRSA, and we have already reported
that MRSA can be eradicated in all patients with atopic dermatitis
in which MRSA [11] is involved. When it is considered thatatopic dermatitis is a superantigen disease, Staphylococcus aureus
control in atopic dermatitis is important. Although this Povidoneiodine solution contains iodine, it has already been reported thatthe thyroid disorder is not recognized even in the examination of
the injury to the thyroid of iodine absorbed from the skin by thetreatment of flushing the Povidone-iodine solution [7,11].

Conclusion

When it is considered that atopic dermatitis is superantigen
disease, measures against Staphylococcus aureus are important.
There has been a large number of reports that if a treatmentthat uses Povidone-iodine solution that can also kill MRSA in
combination with general treatment is used, rapidly and remarkable
improvement of rashes and laboratory data in patients with atopic
dermatitis can be obtained. The Japanese Guidelines for Atopic
Dermatitis Treatment 2018 also stated that the use of Povidoneiodine as adjunctive treatment was used with caution for sideeffects. In the future, it is recommended to use povidone-iodine
together with general treatment in cases where general treatment isnot effective enough as one of the treatments for atopic dermatitis.

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© 2019 Sugimoto K, et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License
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