Extrinsic Atopic Dermatitis Linked to Risk for Eczema Herpeticum

Eczema herpeticum
Eczema herpeticum
The largest case study, and the only study that highlights risk factors for eczema herpeticum recurrence, finds that early age of atopic dermatitis onset not only predisposes patients to eczema herpeticum but also recurrence.

Clinically active extrinsic atopic dermatitis (AD) is associated with an increased risk for eczema herpeticum (EH), a herpes simplex viral infection of inflamed skin, study data published in the Journal of the European Academy of Dermatology and Venereology suggest.

Investigators performed a retrospective analysis that included patients with EH (n=224) who were seen during a 10-year period by dermatologists at 8 European university hospitals. Patients with AD were divided into subsets of extrinsic and intrinsic AD. Patients who presented with elevated total serum immunoglobulin E (IgE) levels of ≥100 kU/L, positive results in standard skin prick tests, positive SX-1- or FX-5-CAP-FEIA, a history of allergic rhinoconjunctivitis, and/or a history of allergic bronchial asthma were considered to have extrinsic AD. Researchers also examined patients’ history and serum levels of anti-HSV-IgM and anti-HSV-IgG antibodies to identify primary or secondary herpes simplex virus infections.

On average, it took 4.2±3.4 days to diagnose EH after patients realized their first symptoms. A total of 133 patients experienced their first EH episode, whereas 17 patients had the infection twice, and another 17 patients were affected by >2 episodes. Extrinsic AD was found to be a risk factor for EH, represented by 184 cases of EH in patients with extrinsic AD compared with only 1 patient who had intrinsic AD (P <.001). Recurrent EH was associated with a younger age at AD onset compared with patients with a single episode of EH (5.4±12.9 years vs 11.1±6.5 years, respectively; P =.016).

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A limitation of the study was its retrospective design, which resulted in missing long-term follow-up data for some of the patients.

Researchers from this study hope their findings “can help to differentiate EH from other skin conditions and will hopefully lead to a faster diagnosis of affected patients.”

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Seegräber M, Worm M, Werfel T, et al. Recurrent eczema herpeticum – a retrospective European multicenter study evaluating the clinical characteristics of eczema herpeticum cases in atopic dermatitis patients [published online November 16, 2019]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.16090