Atopic dermo-respiratory syndrome is a correlate of eczema herpeticum

Abstract

Background: Factors favoring the emergence of eczema herpeticum (EH) in patients with atopic dermatitis (AD) remain elusive. The aim of this work was to identify changes in clinical and laboratory parameters in acute EH patients, before and after 6 weeks of treatment, as well as differences between AD patients with and without a history of EH.

Methods: A total of 235 adult subjects were included and subdivided into six groups: (i) AD patients with acute EH, (ii) AD patients with history of EH, (iii) AD without EH but with recurrent herpes simplex virus (HSV) infections, (iv) AD without EH or recurrent HSV infections and healthy non-AD controls (v) with and (vi) without recurrent HSV infections. Clinical examination of AD, assessment of atopic status and severity were performed. Total IgE, allergen-specific IgE and differential blood count were analyzed. Clinical diagnosis of acute EH was confirmed by PCR.

Results: More male patients with AD were affected by EH than female patients. Acute episodes of EH are characterized by lower levels of lymphocytes and higher levels of monocytes. AD patients with history of EH display higher total IgE serum levels (ADEH(+) HSV(+) vs ADEH(-) HSV(+) , P < 0.001) and higher sensitization profiles and stronger severity of AD (EASI and SCORAD; ADEH(+) HSV(+) vs ADEH(-) HSV(+) , P < 0.001). Concomitant asthma and rhinitis were identified as correlates of EH.

Conclusion: From these data, we conclude that AD patients with EH display a distinct clinical and biological phenotype.

© 2011 John Wiley & Sons A/S.

Figures

Figure 1

Comparison of the SCORAD between Eczema herpeticum patients during the acute phase of the disease and during remission of EH, 4–12 weeks after the acute episode. Additionally the mean ± SD of the SCORAD of the ADEH+HSV+ history group is shown. *p

Figure 2

Mean values of several scores (SCORAD, Diepgen, EASI and Rajka-Langeland-Score) are shown for the ADEH+HSV+ acute, ADEH+HSV+ history and the two other AD+ groups (ADEH−HSV+ and ADEH−HSV−); SD=standard deviation. *p<0.05 = statistically significant [Statistical analysis: these analyses performed on severity scores using analysis of variance (ANOVA) techniques with pairwise comparisons as needed. All severity scores were log 10 transformed except Rajka-Langeland scores.]

Figure 3

Comparison of several clinical items of the Diepgen score between the ADEH+HSV+ history and the ADEH−HSV+ groups. *p<0.05 = statistically significant [Statistical analysis: comparisons of presence or absence of symptom between groups made with Fishers Exact Tests]