The importance of bacteria and other microbes in the genesis of atopic dermatitis has long been recognized by clinicians. Indeed, the immunological profile of atopic dermatitis promotes Staphylococcus aureus colonization, and the germs are found in the majority of individuals with atopic dermatitis, even when skin lesions are absent. Impetiginization symptoms such as weeping and crusting, periauricular fissuration, or tiny superficial pustules are a sensitive signal that S. aureus levels have grown and are a clinical indication of secondarily infected dermatitis.

A recent study on the function of S. aureus in atopic dermatitis, on the other hand, presents evidence that the underlying pathophysiology of atopic dermatitis, namely a disruption of the skin barrier and inflammation of the upper dermis, is dependent on the existence of an infectious process. In other words, secondary S. aureus infection becomes a cause of atopic dermatitis. Secondary fungal infections have gotten less attention, however, there is evidence that Malassezia spp. can play a role in dermatitis with a head and neck distribution pattern. 

A recent study substantially aided the understanding of the pathophysiological potential of S. aureus superantigens in atopic dermatitis, indicating that antibiotic therapy might be an essential part of atopic dermatitis treatment. However, clinical data proved a clear benefit of combination anti-inflammatory and antibiotic treatment against anti-inflammatory treatment alone is still lacking. Although there is agreement that the presence of clinically infected lesions in atopic dermatitis requires a course of particular antibiotic topical therapy, the therapeutic benefit of antibiotic drugs in seemingly uninfected atopic dermatitis, as seen in the majority of patients, is still unknown.

Furthermore, in order to fully analyze the role of particular antibiotic therapy in clinically uninfected atopic dermatitis, the influence of adjuvant skincare on the cutaneous microbiota must be assessed. In the meantime, secondary infections in atopic dermatitis were still an issue in clinical atopic dermatitis management, and particular anti-infective therapy was still a way to fine-tune individual atopic dermatitis treatment.