Establishment of a Superficial Skin

Infection Model in Mice by Using

Staphylococcus aureus and Streptococcus
pyogenes
Elisabeth Kugelberg, Tobias Norstrm, Thomas K.
Petersen, Tore Duvold, Dan I. Andersson and Diarmaid
Hughes
Antimicrob. Agents Chemother. 2005, 49(8):3435. DOI:
10.1128/AAC.49.8.3435-3441.2005.

These include:
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ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Aug. 2005, p. 34353441

0066-4804/05/$08.000 doi:10.1128/AAC.49.8.34353441.2005
Copyright 2005, American Society for Microbiology. All Rights Reserved.

Vol. 49, No. 8

Establishment of a Superficial Skin Infection Model in Mice by Using

Staphylococcus aureus and Streptococcus pyogenes
Elisabeth Kugelberg,1,2 Tobias Norstro
m,3 Thomas K. Petersen,4 Tore Duvold,4
1,2
Dan I. Andersson, and Diarmaid Hughes3*
Department of Bacteriology, Swedish Institute for Infectious Disease Control, S-171 82 Solna, Sweden1; Microbiology and
Tumor Biology Center, Karolinska Institute, S-171 77 Stockholm, Sweden2; Department of Cell and Molecular Biology,
Box 596, The Biomedical Center, Uppsala University, S-751 24 Uppsala, Sweden3; and LEO Pharma,
DK-2750 Ballerup, Denmark4
Received 9 August 2004/Returned for modification 18 September 2004/Accepted 27 April 2005

for studying issues related to infections in burn patients and is

ethically unacceptable from an animal welfare perspective for
the study of localized skin infections, such as impetigo and
erysipelas. The skin suture-wound model involves cutting into
the deeper layers of the skin and is thus not clinically relevant
to purely topical conditions. Here we describe a new mouse
model for superficial infections, the tape-stripping model. In
this model a way of entry for the infectious agent is created by
stripping off the fur and epidermis in a region on the back of
the mouse by successive applications of an adhesive bandage.
In the development of this model, we used S. aureus and S.
pyogenes as the infectious agents. Both bacteria are endemic in
human populations and are regarded as opportunistic bacteria,
usually causing infections in children, immunocompromised
patients, or patients suffering from the effects of medical surgery (11, 22, 35). S. aureus can be isolated from throat or nasal
swab samples from approximately one-third of the population
(2, 16, 26, 33, 34) and is also commonly found in the skin flora,
together with related species, such as Staphylococcus epidermidis (6, 7). Topical infections due to S. aureus and S. pyogenes
are clinically relevant and cause a variety of serious symptoms,
including toxic shock syndrome and skin lesions (17, 31), that
can progress to sepsis and systemic shock if they are left untreated (3, 10, 24). These bacterial species are also the most
common causes of impetigo in humans (13, 17). The antibiotic
used to test the model was 2% fusidic acid in ointment (FAO;
Fucidin ointment). In vitro FAO shows high levels of activity
against several gram-positive organisms and species of staphylococci in particular (19, 20, 23).

An important stage in testing the potential of chemicals as

antimicrobial drug candidates is establishment of their effectiveness in an animal model system (12, 30). A useful animal
model system should be clinically relevant, experimentally robust, ethically acceptable, and convenient to perform and
should provide reliable and reproducible results. We report
here on a new model in mice that fulfills these criteria. The
tape-stripping model has been developed to test the effectiveness of topical antibiotic treatments of superficial skin infections caused by Staphylococcus aureus or Streptococcus pyogenes. S. aureus and S. pyogenes are the most common causative
agents of primary skin infections in humans (11, 17).
The existing mouse models for topical treatment of skin
infections are the burnt skin model (1, 32, 36) and the skin
suture-wound model (5, 14). Either the bacteria are introduced
into the skin by injection in a traumatized skin area, as in the
burnt skin model, or a bacterium-impregnated nylon suture is
implanted into an artificial wound (a scalpel incision through
all skin layers), which is then sewn or stapled shut, as in the
skin suture-wound model. The area of infection in these models is usually dorsally located to hinder grooming or cleaning by
the animal itself. Antibiotics dissolved in cream or ointment
can be applied to the wound during the course of the experiment. At the experimental end point, the animal is killed, the
infected area of the skin is cut out, and the number of bacteria
in the sample is assayed (1, 5, 14, 32, 36). These mouse models
for skin infections have some disadvantages in relation to superficial infections. The burnt skin model has been developed
* Corresponding author. Mailing address: Department of Cell and
Molecular Biology, Box 596, The Biomedical Center, Uppsala University, S-751 24 Uppsala, Sweden. Phone: 46-18-471 4354. Fax: 48-18530396. E-mail: [email protected].
E.K. and T.N. contributed equally to this work.

MATERIALS AND METHODS

Bacterial strains and growth media. Staphylococcus aureus FDA486 is a laboratory strain previously used to study wound infections in rats (25). Streptococcus pyogenes 301 is a clinical dermal infection isolate obtained from the Univer-

3435

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A new animal model for the purpose of studying superficial infections is presented. In this model an infection
is established by disruption of the skin barrier by partial removal of the epidermal layer by tape stripping and
subsequent application of the pathogens Staphylococcus aureus and Streptococcus pyogenes. The infection and the
infection route are purely topical, in contrast to those used in previously described animal models in mice, such
as the skin suture-wound model, where the infection is introduced into the deeper layers of the skin. Thus, the
present model is considered more biologically relevant for the study of superficial skin infections in mice and
humans. Established topical antibiotic treatments are shown to be effective. The procedures involved in the
model are simple, a feature that increases throughput and reproducibility. This new model should be applicable to the evaluation of novel antimicrobial treatments of superficial infections caused by S. aureus and S.
pyogenes.

3436

KUGELBERG ET AL.

ANTIMICROB. AGENTS CHEMOTHER.

TABLE 1. Bacterial counts obtained in the various

treatment groups
Group

Inoculum size
4 h postinfection
Untreated (day 4)
Placebo (day 4)
FAO (day 4)

Mean bacterial count (log10 CFU/wound) SD

(no. of wounds)
S. aureus FDA486a

S. pyogenes 301b

7.21 0.08
7.03 0.37 (7)
5.89 0.64 (8)
6.05 0.31 (7)
4.68 0.78 (12)

7.28 0.11
6.48 0.29 (16)
3.21 1.62 (16)
6.15 0.57 (16)
2.04 1.31 (8)

a
FA placebo (P 0.001); 4 h placebo (P 0.05); 4 h untreated (P
0.01); untreated placebo (P 1.00).
b
FA placebo (P 0.001); 4 h placebo (P 1.00); 4 h untreated (P
0.001); untreated placebo (P 0.001).

RESULTS
Establishment of staphylococcal infection. The number of
CFU recoverable from the wound 4 h after application of 107
CFU of S. aureus FDA486 was 7.03 0.37 log10 (Table 1). The
different treatment regimens were begun after this initial 4-h
period. There was no significant difference (P 0.05) in the
numbers of CFU per wound when 4 h versus 4 days of placebo
treatment were compared (6.05 0.31 log10). This is evidence
of the successful establishment of a staphylococcal infection in
this model. There was a slightly greater reduction in the numbers of CFU per wound that was statistically significant (P
0.01) when 4 h versus 4 days of no treatment (5.89 0.64 log10)
were compared. The differences between the 4-day placebo

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sity Hospital in Uppsala, Sweden. The Dry SPOT Streptococcal Grouping kit
(DR0400 M; Oxoid Ltd., Basingstoke, United Kingdom) was used to determine
the Lancefield type of the streptococcal strain. The streptococcal bacteria were
grown overnight anaerobically at 37C on defibrinated horse blood agar before
they were tested according to the manufacturers instructions. S. pyogenes 301
belongs to Lancefield serological group type A. The in vitro MICs of fusidic acid
for these strains, as determined by Etest (AB BIODISK, Solna, Sweden), were as
follows: S. aureus FDA486, 0.125 g/ml and S. pyogenes 301, 4 g/ml. S. aureus
was grown in Luria broth and on Luria agar plates (Oxoid Ltd.). S. pyogenes was
grown in Todd-Hewitt broth (Sigma Aldrich, Stockholm, Sweden) and on blood
agar plates made by mixing 5% (wt/vol) defibrinated horse blood (National
Veterinary Institute, Uppsala, Sweden) with Luria agar. S. aureus was grown
aerobically at 37C, and S. pyogenes was grown anaerobically (10% CO2) at 37C.
Tape-stripping infection model. Animal infection experiments were performed at the Microbiology and Tumor Biology Center, Karolinska Institute
(Stockholm, Sweden), in accordance with institutional and national guidelines
(ethical permit N154/02). Six- to 8-week-old female BALB/c mice (Taconic
M&B, Ry, Denmark) were used for all experiments. The mice were anesthetized
by intraperitoneal injection of 10 ml/kg of body weight of a 1:1:2 (vol/vol) mixture
of Hypnorm (fentanyl/fluanisone; Janssen-Cilag Ltd., Saunderton, United Kingdom)-Dormicum (midazolam; Hoffman-La Roche AG, Basel, Switzerland)-distilled water. The fur was stripped from the mice with Tensoplast (Smith &
Nephew Medical, Hull, United Kingdom), an elastic adhesive bandage. An area
of ca. 2 cm2 was tape stripped. In order to standardize the degree of barrier
disruption elicited by the tape stripping, the transepidermal water loss (TEWL)
was measured by using a DermaLab TEWL probe (Cortex Technology, Hadsund, Denmark). Measurements were made according to the guidelines of the
Standardization Group of the European Dermatitis Society (27). TEWL is calculated automatically and is expressed in g/m2 h. By tape stripping the back of the
mice 7 to 10 times in succession, the TEWL reached approximately 70 g/m2 h.
Following this procedure, the skin became visibly damaged and was characterized by reddening and glistening but no regular bleeding. Microscopically, this
procedure resulted in the controlled removal of most of the epidermal layer, with
only a few basal epidermal cells remaining. After stripping of the skin, a bacterial
infection was initiated by placing on the skin a 5-l droplet containing 107 cells
concentrated from an overnight bacterial culture in stationary phase. In each
experiment, a group of mice were killed 4 h after infection to control the
infectious dose (Table 1). The mice were treated with FAO (LEO Pharma,
Ballerup, Denmark) on a regular basis, as described here. This dose gave a
significant reduction in the numbers of CFU in preliminary dose-finding studies
(0.5%, 1%, and 2% fusidic acid) and is the dose recommended by the manufacturer for human use. The first application of antibiotic to the stripped skin of the
mice was at 4 h postinfection. Thereafter, beginning at 16 h after the first
treatment, additional antibiotic applications were made twice daily (in the morning and the evening, with an 8-h interval) for a period of 4 days. For each
treatment 25 to 30 mg of ointment was applied (estimated by weighing the pellet
of ointment on a spatula). After each day the ointment tube was weighed to
determine the average amount of ointment used for each mouse. Two infection
control groups were included for each experiment: one consisted of untreated
mice and the other consisted of mice treated with placebo ointment. The placebo
ointment was identical to FAO except for the lack of the 2% fusidic acid. For all
experiments in which untreated or topically treated groups were included, the
experiments were terminated 18 h after the last topical treatment in order to
avoid carryover effects in vitro. The addition of fucidinase (2.5 units per sample)

to the homogenized samples did not influence the numbers of CFU, showing that
18 h is sufficient to avoid a carryover effect. Immediately after the mice were
killed, the wounds, approximately 2 cm2, were excised and homogenized together
with 1 ml of phosphate-buffered saline in stomacher lab system bags by using a
Stomacher 80 machine (Seward Ltd., Thetford, United Kingdom) set at 260
strokes per min for 120 s. The homogenates were washed once in phosphatebuffered saline to decrease the concentration of ointment. Suitable dilutions of
the homogenates were plated on Luria agar (S. aureus) or blood agar (S. pyogenes) plates to determine the number of living bacteria (CFU). In order to
investigate the reproducibility of the infection with S. aureus and S. pyogenes,
three independent experiments that included untreated and placebo-treated
groups were performed. In each experiment the mean CFU was calculated by
using log10-transformed data. Based on the averages of these three experiments,
the mean, range, and coefficient of variation were calculated.
Suture-wound model. The established skin suture-wound model was carried
out as described previously (14).
Histological examinations. In order to characterize the histopathology of the
model, biopsy specimens were taken after the following treatments: immediately
after tape stripping, 4 days after tape stripping, and 4 days after inoculation with
S. aureus and S. pyogenes with and without treatment with placebo ointment.
Immediately after the animals were killed, 5-mm punch biopsy specimens of
excised skin were taken and immediately fixed in phosphate-buffered (pH 7.4)
formalin (4%). The formalin-fixed biopsy specimens were embedded in paraffin
and stained with hematoxylin and eosin. For identification of the bacteria, the
biopsy specimens were stained with Grams crystal violet solution (94448; SigmaAldrich). The following parameters and semiquantitative scoring system were
used to describe the inflammatory response: for scoring of the inflammation (in
the dermis, subcutis, muscular tissue, and connective tissues), 0, no inflammation
present; 1, little inflammation present; 2, moderate inflammation present; and 3,
severe inflammation present; for scoring of the presence of neutrophils, 0, no
neutrophils present; 1, a few neutrophils present; 2, moderate occurrence of
neutrophils; and 3, abundant occurrence of neutrophils; for scoring of the presence of mononuclear leukocytes, 0, no mononuclear leukocytes present; 1, a few
mononuclear leukocytes present; 2, moderate occurrence of mononuclear leukocytes; and 3, abundant occurrence of mononuclear leukocytes; for scoring of
presence of bacteria, 0, no bacteria; 1, scattered bacteria; 2, moderate numbers
of bacteria; and 3, many large collections of bacteria. The observer was blinded
to the treatments for all biopsy specimens.
Behavioral responses of mice. The mice were observed at least twice each day
for signs of fatigue, stress, and aggressiveness. The mice were weighed before and
after each experiment.
Statistical analysis. Statistical analysis of the log10-transformed data was performed to ensure variance homogeneity and normality. Thus, an analysis of
variance (generalized linear models [8]) was applied, followed by four predefined
pairwise treatment comparisons adjusted for multiplicity by the Bonferroni
method (18), yielding a statistical ranking. Furthermore, to ensure robustness in
the analysis performed, the nonparametric Kruskal-Wallis approach (21) was
used. The method showed no conclusive dissimilarities to the generalized linear
models approach. All testing was performed on an overall 5% significance level,
meaning that P values less than 0.05 were considered a statistically significant
difference. All calculations and analyses were performed with SAS version 8.2
(SAS OnlineDoc; SAS Institute Inc., Cary, NC). Log10-transformed data are
presented as the mean and standard deviation (SD) in Table 1, whereas actual
values and corresponding median values are presented in the figures.

VOL. 49, 2005

A NEW SUPERFICIAL SKIN INFECTION MODEL IN MICE

treatment and 4 days of no treatment were not statistically

significant (P 1.00).
Effect of fusidic acid treatment on staphylococcal infection.
Tape-stripped mice infected with S. aureus FDA486 were
treated with FAO to test the efficacy of a topical antibiotic
treatment in the new model (Fig. 1). Comparison of placebo
(6.05 0.31 log10) and FAO (4.68 0.78 log10) treatment of
the staphylococcal infection revealed a reduction in the numbers of CFU per wound that was statistically significant (P
0.001).
Establishment of streptococcal infection. The numbers of
CFU recoverable from the wound 4 h after application of
approximately 107 CFU of S. pyogenes 301 was 6.48 0.29
log10 (Table 1). Comparison of the numbers of CFU after 4 h
and 4 days of placebo treatment (6.15 0.57 log10) revealed
no significant difference (P 1.00). In contrast, comparison of
the numbers of CFU at 4 h and 4 days without treatment (3.21
1.62 log10) revealed a significant reduction (P 0.001).
Comparison of the placebo and the untreated groups 4 days
after infection confirmed the significance of the reduction in
the numbers of CFU in the latter group (P 0.001).
Effect of fusidic acid treatment on streptococcal infection.
Comparison of placebo and fusidic acid treatments for the
streptococcal infection (Fig. 2; Table 1) revealed a very significant effect (P 0.001) of the antibiotic in clearing the infection. Thus, the mean CFU count after the 4-day FAO treatment (2.04 1.31 log10) was reduced more than 4 log10
compared with that after the 4-day placebo treatment (6.15
0.57 log10). Statistical comparison of the 4-day FAO treatment
group and the 4-day untreated group showed that there was no
significant difference (P 0.05).
Reproducibility of the model. The reproducibility of the
model was assessed in three independent experiments, each of
which included both S. aureus and S. pyogenes, with untreated

FIG. 2. Tape-stripped mice infected with S. pyogenes 301. The

number of bacteria (CFU) extracted from each mouse is represented
by the symbol for the corresponding experimental group. The median
value of the data for each group is shown as a horizontal bar. The
number of mice in each experimental group was as follows: 4 h postinfection, n 16; untreated, n 16; placebo, n 16; FAO, n 8.

and placebo-treated mice. The coefficients of variance (CVs)

for the untreated mice were 18% (mean, 6.09 log10; SD, 1.10
log10) for those infected with S. aureus and 36% (mean, 3.96
log10; SD, 1.41 log10) for those infected with S. pyogenes. The
CVs for the placebo-treated mice were 30% (mean, 6.21 log10;
SD, 1.86) for those infected with S. aureus and 12% (mean,
6.62 log10; SD, 0.81 log10) for those infected with S. pyogenes.
Histological examination of infected and noninfected mice.
The results for the scores of the inflammatory response, infiltrating neutrophils and mononuclear leukocytes, and the presence of bacteria are presented in Table 2. The tape-stripping
procedure removed most of the epidermis, although a single
layer of epidermal cells or scattered epidermal cells remained.
Most of the remaining epidermal cells were necrotic. A minimal inflammatory response was evident immediately after tape
stripping, and except for the missing epidermis, the skin appeared normal. Four days after tape stripping an acute subcutaneous phlegmonous inflammation with fibrin deposition and
edema was observed with the infiltration of a few neutrophils.
The inflammation was most pronounced in the subcutaneous
and connective tissues. Inoculation of both S. aureus and S.
pyogenes induced a late stage of subcutaneous fibrinoid necrosis after 4 days, with a few neutrophils mainly seen as nuclear
dust deep in the subcutis (Fig. 3). In addition to neutrophils,
the inflammatory cell infiltrate consisted of mononuclear cells,
including lymphocytes and histiocytes. The inflammatory response was most intense in the subcutaneous tissues. For both
mice infected with S. aureus and mice infected with S. pyogenes,
the presence of bacteria (Fig. 4) was less evident in the untreated mice than in placebo-treated mice and the skin appeared dry compared to the skin of the placebo-treated mice.
In some of the infected animals, fibrosis and remarkable regeneratory changes were observed in the subcutaneous tissue.

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FIG. 1. Tape-stripped mice infected with S. aureus FDA486. The

number of bacteria (CFU) extracted from each mouse is represented
by the symbol for the corresponding experimental group. The median
value of the data for each group is shown as a horizontal bar. The
number of mice in each experimental group was as follows: 4 h postinfection, n 7; untreated, n 8; placebo, n 8; FAO, n 12.

3437

3438

KUGELBERG ET AL.

ANTIMICROB. AGENTS CHEMOTHER.

TABLE 2. Scores for inflammatory response, infiltrating

neutrophils and mononuclear leukocytes, and presence of bacteria
Group, day, and parameter

Meana

Untreated
Mean

Tape-stripped skin
Day 0 (n 8)
Inflammation score
Dermal
Subcutaneous
Muscular
Connective tissue
Neutrophils
Mononuclear
leukocytesb
Presence of bacteria

SD

Mean

SD

DISCUSSION
0.0
0.1
0.0
0.0
0.0
0.0

0.0
0.4
0.0
0.0
0.0
0.0

0.0

0.0

0.8
2.6
0.3
1.3
0.3
0.0

1.4
0.5
0.7
1.3
0.3
0.0

0.0

0.0

S. aureus, day 4c
Inflammation score
Dermal
Subcutaneous
Muscular
Connective tissue
Neutrophils
Mononuclear leukocytesb
Presence of bacteria

1.3
2.5
0.4
0.4
0.6
0.4
0.6

1.2
0.8
0.5
0.5
0.6
0.2
0.7

0.0
2.4
1.6
1.1
0.5
1.2
3.0

0.0
0.9
1.1
0.5
0.4
1.7
0.0

S. pyogenes, day 4d
Inflammation score
Dermal
Subcutaneous
Muscular
Connective tissue
Neutrophils
Mononuclear leukocytesb
Presence of bacteria

0.0
2.8
0.3
0.5
0.3
0.3
0.3

0.0
0.5
0.5
1.0
0.5
0.3
0.3

1.2
2.2
1.6
1.1
0.7
1.7
2.4

1.3
1.3
1.1
0.5
0.3
0.7
1.3

Scoring quantification is described in Materials and Methods.

Mononuclear leukocytes include lymphocytes and histiocytes.
c
Eight mice were in the untreated group and six mice were in the placebo group.
d
Five mice were in the untreated group and five mice were in the placebo group.
b

Behavioral responses of the mice. No abnormal behavioral

patterns, such as fatigue, stress, or aggressiveness, were observed among the mice at any time during the course of these
experiments. The mice gained, on average, 0.5 g of weight

We have established a new model for superficial skin infections caused by S. aureus and S. pyogenes which we suggest to
be a relevant and useful model for localized skin infections in
humans. In contrast to previously described models for skin
infection (1, 5, 14, 32, 36), the infection route in our model is
topical. Partial removal of the epidermal layer of the skin
allowed both S. aureus and S. pyogenes to colonize the skin and
to elicit a profound inflammatory response. TEWL, which is a
measure of skin barrier integrity, was used in order to ensure
that the same degree of barrier disruption was achieved in all
the mice and, thereby, to increase the reproducibility of the
model.
The infection was maintained throughout the 4-day duration
of the experiment (placebo groups). Thus, in the placebo
groups, from an initial infection with 107 bacteria of either
species, the number of CFU recovered from each wound
dropped by less than 1 log10 over the course of the 4-day
treatment. Topical treatment with FAO significantly reduced
the numbers of S. aureus and S. pyogenes CFU recoverable
after the 4-day treatment (Fig. 1 and 2; Table 1), showing that
an established topical treatment is effective in the model. For
both S. aureus and S. pyogenes, the numbers of recoverable
CFU were different when the mice were left untreated for 4
days and when the mice were left untreated for 4 h (Table 1).
For S. aureus this number was significantly higher (1.2 log10; P
0.001) than that for the fusidic acid-treated group. For S.
pyogenes the number of bacteria was also 1.2 log10 higher in the
untreated groups than in the fusidic acid-treated animals, although this difference was not significantly different (P 0.05).
A plausible explanation for this is that S. pyogenes grows best
under microanaerobic conditions (17) and that such conditions
are more closely approximated by the presence of ointment in
this assay. The genetic background of the BALB/c mice may
also explain the reduced number of streptococci in the untreated group, as BALB/c mice have been shown to be much
more resistant to group A streptococci than C3H/HeN mice
(15). However, the use of more susceptible mouse strains may
lead to an unacceptably high mortality rate, as observed in
C3H/HeN when they are exposed to streptococci. In our
model, BALB/c mice were used because the dominating agent
in superficial infections, S. aureus (11, 17), colonized these
mice well. BALB/c mice are also considered relevant because

FIG. 3. Histological appearance of normal dorsal skin of mice (A; magnification, 100) and Staphylococcus aureus-infected skin lesion (B,
magnification, 100; C [boxed area in panel B], magnification, 200; D [boxed area in panel C], magnification, 1,000) on day 4. Biopsy specimens
were taken immediately after the termination of the experiment, fixed in formalin, and embedded in paraffin. The biopsy specimens were stained
with hematoxylin and eosin. The inflammatory cell infiltrate consists of mononuclear cells, including lymphocytes, histiocytes, and, to lesser extent,
neutrophils. The inflammatory response is associated with marked fibrosis, edema, and fibrin deposition. Coccoid bacteria are present. The
epidermal layer is absent in the infected lesions. Numbered arrows indicate the following: 1, epidermis; 2, dermis; 3, muscular layer; 4, bacteria;
5, fibrin deposition; 6, inflammatory cell infiltrate.

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Day 4 (n 8)
Inflammation score
Dermal
Subcutaneous
Muscular
Connective tissue
Neutrophils
Mononuclear
leukocytesb
Presence of bacteria

Placebo

SD

during the experiment, with no differences between the various

test groups. A small fraction (2 of 48) of the mice displayed
signs of deeper infections, with necrotized tissue and softening
of the backbone skeletal structure (data not shown).

3439
A NEW SUPERFICIAL SKIN INFECTION MODEL IN MICE
VOL. 49, 2005

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3440

KUGELBERG ET AL.

they respond immunologically to the superantigens (staphylococcal enterotoxin B) produced by S. aureus (29).
A pronounced and significant reduction in the numbers of
CFU was achieved following 4 days of treatment with FAO.
However, complete eradication of the staphylococci and streptococci was not reached after 4 days of treatment. This was
expected, as superficial infections normally should be treated
for 7 to 10 days in order to obtain a successful outcome (13).
The fact that the infection was not cleared after this time
allows the model to be used to compare various antimicrobial
treatments with FAO.
Histologically, inoculation with S. aureus and S. pyogenes
induced a pronounced acute inflammatory response characterized by the presence of neutrophils, lymphocytes, histiocytes,
and fibrin deposition. The inflammatory response included
most of the layers of the skin. Considering the histology of the
infection caused by the staphylococci and streptococci, it most
resembles that of human erysipelas, except that our model
lacks the epidermal layer. Erysipelas is an acute bacterial infection of the dermis and subcutaneous tissues that is associated with clinical inflammation. Erysipelas is generally caused
by group A streptococci (4). The model has less resemblance to
the histology of impetigo, which is a contagious superficial

pyogenic infection of the skin caused by S. aureus and S. pyogenes. In impetigo, the epidermis splits just below the stratum
granulosum and large subcorneal pustules are formed, and
these may also contain bacteria. The upper dermis contains an
inflammatory infiltrate of neutrophils and lymphocytes (9). In
our murine model, the formation of subcorneal pustules does
not occur. We propose that our model would be a relevant
disease model for localized skin structure infections caused by
S. aureus or S. pyogenes, which can occur following skin barrier
disruption.
The disruption of the barrier by using tape stripping resulted
in a homogeneous removal of the upper epidermal layers in all
the biopsy specimens examined immediately after tape stripping. Considering the numbers of CFU, the reproducibility of
the model is acceptable, in that it has CVs that ranged from
12% to 36%, depending on the strain and the treatment.
The tape-stripping model presented here is relatively painless and nonintrusive for the animal. It is technically quick and
simple to perform, with only a few uncomplicated steps involved in preparing the animals for treatment. In the process of
validating this new model, we also performed some preliminary experiments using the established skin suture-wound
model (14). In our hands, the throughput time per mouse (the
total time taken to prepare a wound and inoculate it with
bacteria) was approximately 2 min for the tape-stripping
model, whereas it was at least 20 min for the skin suture-wound
model. The reduction in the time required to process each
animal by use of the tape-stripping model relative to that
required by use of the skin suture-wound model provides a
significant advantage when one is dealing with many animals.
Considering the reduction of the numbers of CFU following
treatment with FAO, the efficacy of fusidic acid is in agreement
with those detected in previous investigations of FAO, e.g., by
use of the skin suture-wound model (14, 28). Also, the variability in the model appears to be comparable to that detected
in previous studies with the skin suture-wound model (14).
In conclusion, partial removal of the epidermal layer of
BALB/c mouse skin by tape stripping allows S. aureus and S.
pyogenes to colonize the skin, and this colonization is associated with an inflammatory host response, as determined by
histology. Infections with both S. aureus and S. pyogenes can be
treated by topical administration of FAO. The model is simple
and reproducible and can be used for the evaluation of new
antibiotic treatments for superficial skin infections. The model
may also be advantageous for studies of the mechanisms involved in superficial skin infections.
ACKNOWLEDGMENTS
We acknowledge financial support from the Swedish Research
Council (to D.I.A. and D.H.), the Swedish Institute for Infectious
Disease control (to D.I.A.), the EU (to D.H.), and LEO Pharma (to
D.I.A. and D.H.).
Dorthe Sandvang and Niels Frimodt-Mller, Statens Serum Institut,
Copenhagen, are gratefully acknowledged for their help in preparing
samples for histological analysis. Jonas Wiedemann, LEO Pharma, is
acknowledged for helpful assistance with the statistical analysis.
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FIG. 4. Staining of gram-positive bacteria in Staphylococcus aureusinfected skin (magnification, 1,000) on day 4. Biopsy specimens were
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A NEW SUPERFICIAL SKIN INFECTION MODEL IN MICE