A report describes the case of a 9-year-old Caucasian boy suffering from chronic atopic dermatitis (AD) since the age of 1 year. He gave a history of spending much time at a horse riding center and reported deteriorating pruritus and scabs on his face, trunk and extremities along with diffused skin dryness and a very serious itchy plaque on his lower left limb. Since, no laboratory test is required to identify AD, the diagnosis was made based on clinical examination and medical history. 

He gave a history of undergoing skin prick tests for respiratory or food allergies, and patch tests for contact dermatitis, which all resulted negative. The serum level of total immunoglobulin E was also found to be within the normal range. He gave a history of utilizing topical steroids (including hydrocortisone butyrate 0.1%, mometasone furoate 0.1%) and inhibitors of calcineurin (tacrolimus and pimecrolimus) with minimal benefit. Followed by treatment with deflazacort oral solution at a dosage of 1 mg/kg/die for 20 days in several cycles, but his disease flared up again.

On examination, he showed visible Dennie-Morgan lines, inflamed, erythematous papules and crusty plaques scattered over 75% of his face and body, resulting in an eczema area and severity index (EASI) score of 19. A reddish plaque was also seen on his left leg, which was resistant to both steroidal and antimicrobial topical treatments. A culture test of skin scraped specimen was performed which revealed an Enterococcus faecalis on the lesion, which allowed to choose the most effective antibiotic drug. This caused a rapid improvement of the infected skin lesion. 

Source: Malara G, Trifirò C, Bartolotta A, et al. A rare skin infection in atopic dermatitis: acase report. Clin Case Rep. 2020;8(12):2945-7.