Skin Barrier Function and Staphylococcus aureus Colonization in Vestibulum Nasi and Fauces in Healthy Infants and Infants with Eczema: A Population-Based Cohort Study

PLoS One. 2015 Jun 12;10(6):e0130145. doi: 10.1371/journal.pone.0130145. eCollection 2015.


Atopic eczema (AE) is associated with Staphylococcus aureus (S. aureus) colonization and skin barrier dysfunction, often measured by increased transepidermal water loss (TEWL). In the present study, the primary aim was to see whether S. aureus colonization in the vestibulum nasi and/or fauces was associated with increased TEWL in infants with healthy skin and infants with eczema. Secondarily, we aimed to investigate whether TEWL measurements on non-lesional skin on the lateral upper arm is equivalent to volar forearm in infants. In 167 of 240 infants, recruited from the general population, TEWL measurements on the lateral upper arm and volar forearm, using a DermaLab USB, fulfilled our environmental requirements. The mean of three TEWL measurements from each site was used for analysis. The infants were diagnosed with no eczema (n = 110), possible AE (n = 28) or AE (n = 29). DNA samples were analysed for mutations in the filaggrin gene (FLG). Bacterial cultures were reported positive with the identification of at least one culture with S. aureus from vestibulum nasi and/or fauces. S. aureus colonization, found in 89 infants (53%), was not associated with increased TEWL (i.e. TEWL in the upper quartile), neither on the lateral upper arm or volar forearm (p = 0.08 and p = 0.98, respectively), nor with AE (p = 0.10) or FLG mutation (p = 0.17). TEWL was significantly higher on both measuring sites in infants with AE compared to infants with possible AE and no eczema. FLG mutation was significantly associated with increased TEWL, with a 47% difference in TEWL. We conclude that S. aureus in vestibulum nasi and/or fauces was not associated with TEWL, whereas TEWL measurements on the lateral upper arm and volar forearm appear equally appropriate in infants.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cohort Studies
  • Colony Count, Microbial
  • Eczema / microbiology*
  • Eczema / pathology*
  • Eczema / physiopathology
  • Epidermis / pathology
  • Female
  • Filaggrin Proteins
  • Humans
  • Infant
  • Intermediate Filament Proteins / genetics
  • Male
  • Mutation / genetics
  • Skin / microbiology*
  • Skin / pathology*
  • Skin / physiopathology
  • Staphylococcal Infections / microbiology
  • Staphylococcal Infections / pathology
  • Staphylococcal Infections / physiopathology
  • Staphylococcus aureus / growth & development
  • Staphylococcus aureus / physiology*
  • Water Loss, Insensible


  • FLG protein, human
  • Filaggrin Proteins
  • Intermediate Filament Proteins

Grant support

This work was supported by the Arne Ingels Foundation ( (TLB), and the Norwegian Asthma and Allergy Association ( (TLB). The funders had no role in the study design, data collection, analysis, decision to publish, or preparation of the manuscript.