Eczema Herpeticum Research Articles

Whole genome sequencing identifies novel genetic mutations in patients with eczema herpeticum.

Eczema herpeticum (EH) is a rare complication of atopic dermatitis (AD) caused by disseminated herpes simplex virus (HSV) infection. The role of rare and/or deleterious genetic variants in disease etiology is largely unknown. This study aimed to identify genes that harbor damaging genetic variants associated with HSV infection in AD with a history of recurrent eczema herpeticum (ADEH+). Whole genome sequencing (WGS) was performed on 49 recurrent ADEH+ (≥3 EH episodes), 491 AD without a history of eczema herpeticum (ADEH-) and 237 non-atopic control (NA) subjects. Variants were annotated, and a gene-based approach (SKAT-O) was used to identify genes harboring damaging genetic variants associated with ADEH+. Genes identified through WGS were studied for effects on HSV responses and keratinocyte differentiation. Eight genes were identified in the comparison of recurrent ADEH+to ADEH-and NA subjects: SIDT2, CLEC7A, GSTZ1, TPSG1, SP110, RBBP8NL, TRIM15, and FRMD3. Silencing SIDT2 and RBBP8NL in normal human primary keratinocytes (NHPKs) led to significantly increased HSV-1 replication. SIDT2-silenced NHPKs had decreased gene expression of IFNk and IL1b in response to HSV-1 infection. RBBP8NL-silenced NHPKs had decreased gene expression of IFNk, but increased IL1b. Additionally, silencing SIDT2 and RBBP8NL also inhibited gene expression of keratinocyte differentiation markers keratin 10 (KRT10) and loricrin (LOR). SIDT2 and RBBP8NL participate in keratinocyte's response to HSV-1 infection. SIDT2 and RBBP8NL also regulate expression of keratinocyte differentiation genes of KRT10 and LOR.

Design and evaluation of a multiplex vesicular rash PCR for the detection of varicella zoster virus and herpes simplex virus

Varicella zoster virus (VZV) typically infects the skin leading to chickenpox (varicella) and herpes zoster whereas herpes simplex virus 1 and 2 (HSV-1/-2) often affect the mucosa forming herpes labialis and genital herpes. However, in eczema herpeticum and herpes gladiatorum, HSV infections occur on the skin. The cutaneous infections with VZV or HSV often present similar clinical manifestations causing trouble in differentiation.

Lipid Profiles in Eczema Herpeticum and Eczema Vaccinatum Reflect Changes that Predispose to Disseminated Viral Infection

Atopic dermatitis (AD) is the most common inflammatory skin disease. Less than 5% of AD is complicated by eczema herpeticum (EH) and eczema vaccinatum (EV) but this has led to the CDC recommendation that all AD should not receive smallpox vaccination. Biomarkers of susceptibility to EH and EV are not known.

Eczema Herpeticum in children with burns.

Background & Objective:Eczema herpeticum (EH) is a disseminated viral infection occurring in pre-existing skin conditions and burns. The objective of this study was to determine the frequency, treatment, and outcome of EH in pediatric burn patients.Methods:This retrospective study was conducted in the pediatric surgery department, King Edward Medical University/ Mayo Hospital, Lahore, from October 2015 to July 2018 after ethical approval. All pediatric burn patients diagnosed with EH and not sensitive to Acyclovir or suffering from chemical burns were enrolled in the study. Diagnosis was confirmed by presence of umbilicated lesions in burnt area and a positive Tzanck smear. Intravenous acyclovir and supportive treatment was started. Mortality, development of contractures, length of hospital stay/ time for wound healing, re-activation of EH was calculated.Results:Out of 3958 admitted pediatric burn patients, 94(2.4%) developed EH. Girls were 58(61.7%) and boys were 36(38.3%). Mean age was 5.16 ±2.88 years. Scald burn was in 43(45.7%) patients, flame burn in 48(51.1%) patients, and electric flash burn in 3(3.2%) patients. Mean TBSA was 21.74+10.38%. Vesicular eruptions settled in 92 (97.9%) patients after treatment with acyclovir. Mean duration of treatment was 19.89+ 8.9 days and hospital stay was 29.84+ 16.98 days. Twenty three patients (24.5%) developed contractures and two patients (2.1%) developed disseminated EH and expired. Six (6.4%) patients had re-activation of EH.Conclusion:EH occurred in 2.4% of admitted pediatric burn patients. Intravenous acyclovir was successful in 97.9% of the patients, although 2.1% developed disseminated EH and expired. Re-activation occurred in 6.4% of the cases and was associated with prolonged hospital stay.

Review of Scabies Infestation and Selected Common Cutaneous Infections.

1. Ross Brockman, DO* 2. Sabra Leitenberger, MD* 1. *Department of Dermatology, Oregon Health and Science University, Portland, OR * Abbreviations: CDC: : Centers for Disease Control and Prevention CLIA: : Clinical Laboratory Improvement Amendments of 1988 CNS: : central nervous system EH: : eczema herpeticum FDA: : Food and Drug Administration GABHS: : group A β -hemolytic Streptococcus HFMD: : hand-foot-mouth disease HSV: : herpes simplex virus MC: : molluscum contagiosum PCR: : polymerase chain reaction Scabies is a common infestation of childhood but it can have an atypical appearance during infancy, with exuberant inflammation and pustules. We review the diagnosis and management of scabies, with emphasis on issues specific to the pediatric population. There is a wide range of infections that can also cause pustules in early childhood, and several of the most common are highlighted in this article to help the clinician differentiate these entities and select appropriate treatment strategies based on best-available evidence. After completing this article, readers should be able to: 1. Recognize the variable presentation of scabies in infants, children, and immunosuppressed individuals. 2. Understand best-practice strategies for treating scabies, including that the first-line medication is permethrin 5% cream and all household contacts should be treated. 3. Inflammation of molluscum lesions is often related to immune response and imminent clearance. 4. Topical corticosteroids may be used to treat underlying dermatitis in eczema herpeticum, provided the patient is receiving adequate systemic antiviral treatment. 5. Atypical presentations of hand-foot-mouth disease can mimic eczema herpeticum. 6. Onychomadesis may occur after hand-foot-mouth disease. In this article, scabies infestation in infants and young children is covered in detail. In addition, the following common diagnoses with infectious etiologies that can also cause widespread pustules in children are reviewed: molluscum contagiosum, 2 manifestations of herpes simplex virus (HSV) infections (eczema herpeticum [EH] and neonatal HSV), hand-foot-mouth disease (HFMD), and impetigo. Tips on how to recognize these entities, information on pathophysiology, and treatment updates are reviewed herein and summarized in the Table. It is important to consider that a full differential diagnosis of a pustular rash in children may additionally include many other infectious and noninfectious etiologies. …

Наблюдение коморбидности синдрома Марфана с тяжелым атопическим дерматитом: необходимость ранней диагностики и лечения пациентов с аллергодерматозами в детском возрасте

We report a case of a rare combination of Marfan syndrome and severe atopic dermatitis (AD) in a 32-year-old male patient. He developed AD in early childhood and then had a relapse at the age of 18 years caused by stress. After this, AD became severe due to stress associated with aortic aneurysmectomy. The patient also had side effects caused by steroids, including multiple pustular eruptions, Kaposi's varicelliform eruption, edema and hyperemia of the periorbital area, pain and swelling of the small joints of the hands. These side effects, as well as specific cardiovascular symptoms typical of Marfan syndrome necessitated the search for alternative treatment strategies for severe AD. Eventually, we managed to find an effective treatment regimen that caused no side effects or adverse events, while the symptoms subsided. This case demonstrates the importance of early AD diagnosis in childhood in order to prevent its transition into severe chronic form that can hardly be managed in adulthood. Key words: atopic dermatitis, children, diagnostic criteria, clinical manifestations, hereditary diseases, Marfan syndrome

Commentary on Eye Eczema Herpeticum

Commentary on Eye Eczema Herpeticum

Eczema herpeticum: A clinical diagnosis not to be missed

Eczema herpeticum is an uncommon complication of atopic dermatitis, but often has a typical recognisable appearance. This report serves to highlight this feature in a patient who was misdiagnosed initially with a bacterial skin infection and then with a severe cutaneous drug reaction.

Atopic dermatitis in South African children: Experience from a tertiary-care centre

Background. Atopic dermatitis (AD) is a chronic, pruritic condition with significant morbidity and some variation in clinical characteristics across different populations. Objectives. To describe the characteristics and management of AD in a paediatric cohort. Methods. A cross-sectional, descriptive study of paediatric AD patients attending the skin clinic at the King Edward VIII Hospital in Durban, South Africa, is described. Results. The observed prevalence of AD was 60.1%. A preponderance of male patients (55.6%) was seen across the cohort. An onset of AD by 1 year of age was reported in more than half (53.5%) of the patients. Slightly more than a third of the patients presented with severe disease, as determined by affected body surface area (≥50%). The head, neck and limbs were the most involved areas. Eczema herpeticum was the most common co-existing dermatosis (2.4%). Bleach baths (2%), wet wrap therapy (3.6%) and systemic immunosuppressants (4.8%) were used in the management of recalcitrant cases. Conclusion. The observed prevalence of AD is one of the highest documented among paediatric skin diseases in hospital-based studies in Africa. Predominance in children of preschool age, onset of disease by the age of 5 years, co-existing eczema herpeticum and recalcitrant disease requiring systemic immunosuppressants are consistent with trends in patients from European or Asian descent, while the level of severe disease and head and neck involvement are more consistent with reports from Africa. Further studies in a local context are needed to better understand the disease and its presentation in different populations.

A case of eczema herpeticum with Hailey–Hailey disease: A potential diagnostic pitfall

A case of eczema herpeticum with Hailey–Hailey disease: A potential diagnostic pitfall

P550 DIFFERENCES IN ADMISSION COMPLETE BLOOD COUNT PARAMETERS IN ECZEMA HERPETICUM IN CHILDREN

Eczema herpeticum (EH) is a significant infectious complication of atopic dermatitis (AD). However, the clinical diagnosis of EH can be challenging as AD exacerbation and bacterial infection may be mistaken for EH. This may impact treatment decision pending herpes simplex virus polymerase chain reaction (PCR) results. In this study, we investigated whether complete blood count (CBC) can distinguish EH from AD patients with bacterial infections or exacerbation.

Eczema herpeticum in an infant – a case report

Eczema herpeticum is a chronic dermatosis with erosive and ulcerative lesions of the skin in children of a predominantly young age. The clinical case presented in this article shows the severe course of herpesvirus infection combined with atopic dermatitis in a 5-month infant. A rash in the form of vesicles and pustules throughout the body with a predominant localisation on the skin of the face, the scalp, neck, and chest was found in the course of the examination of the child. Influence of infections on the course of allergic processes is an ambiguous and complicated issue. It has been proved that an infection can contribute to the development of allergies and exacerbate the course of already existing allergic inflammation. In recent years, an increasing number of studies have shown the preventive effect of infection on the development of allergic pathology in children, especially during the first years of life.

Pooled safety analysis of baricitinib in adult patients with atopic dermatitis from 8 randomized clinical trials.

Janus kinase (JAK) inhibition is a new mode of action in atopic dermatitis (AD); clarity about drug class safety considerations in the context of AD is important. Baricitinib, an oral, reversible, selective inhibitor of JAK1/JAK2, is in late-stage development for adult patients with moderate-to-severe AD. To report pooled safety data for baricitinib in patients with moderate-to-severe AD in the clinical development program including long-term extension (LTE) studies. This analysis included patient-level safety data from six double-blinded, randomized, placebo-controlled studies (one phase 2 and five phase 3), one double-blinded, randomized, LTE study and one open-label LTE study, reported in three data sets: placebo-controlled, 2-mg - 4-mg extended and All-bari AD. Safety outcomes include treatment-emergent adverse events, adverse events of special interest and abnormal laboratory changes. Proportions of patients with events and incidence rates were calculated. Data were collected for 2531 patients who were given baricitinib for 2247 patient-years (median duration 310days). The frequency of serious infections, opportunistic infections and conjunctival disorders was low and similar between treatment groups in the placebo-controlled period. The most common serious infections were eczema herpeticum [n=11, incidence rates (IR)=0.5], cellulitis (n=6, IR=0.3) and pneumonia (n=3, IR=0.1). There were four opportunistic infections (IR=0.2). No malignancies, gastrointestinal perforations, positively adjudicated cardiovascular events or tuberculosis were reported in the placebo-controlled period in baricitinib-treated patients. Frequency of herpes simplex was higher in the 4-mg group (6.1%) vs. the 2-mg (3.6%) and placebo group (2.7%); IRs in the extended data set (2-mg IR=9.6; 4-mg IR=14.5) were lower vs. the placebo-controlled data set (2-mg IR=12.4; 4-mg IR=21.3). In the All-bari AD data set, there were two positively adjudicated major adverse cardiovascular events (2-mg group): two venous thrombosis events (4-mg group) and one death. This integrated safety analysis in patients with moderate-to-severe AD confirms the established safety profile of baricitinib.

349 S. aureus superantigens enhance viral pathogenesis of the skin epithelium

Atopic dermatitis (AD) is characterized by skin barrier dysfunction, type 2 immunity, and an altered skin microbiota with high S. aureus abundance. Eczema vaccinatum (EV) is one of the most serious AD-associated viral infections and occurs following exposure to vaccinia virus (VV; smallpox vaccine). Previously we had observed that eczema herpeticum, another AD viral complication, was more commonly observed in S. aureus colonized patients. This led us to hypothesize that S. aureus virulence factors (e.g. superantigens [SAgs]) enhance epithelial cells susceptibility to viral infections. To test this, primary human foreskin keratinocytes (PHFK) were incubated with supernatants from multiple S. aureus strains that vary in secreted virulence factors (USA300, HG003, RN4220) and then infected with VV. Treatment of PHFK with USA300 supernatant, which contained the greatest number and quantity of SAgs, resulted in a significant increase in both plaque number and size. USA300 supernatant treatment also resulted in a significant reduction in transepithelial electrical resistance (e.g. barrier function). We have identified the S. aureus SAg, SElQ, as a virulence factor of interest as it is highly produced by USA300 and was detected on the skin of 100% of AD patients in a pilot study. Treatment of PHFK with purified SElQ decreased barrier function, enhanced viral permissiveness, and altered cellular integrity and metabolism. These changes were not observed in PHFK treated with the most homologous SAgs to SElQ, namely SElK and SElM. Our findings suggest that S. aureus SAgs, and uniquely SElQ, significantly alter PHFK and enhance their permissiveness to VV infection and spread. Based on these findings, S. aureus virulence factors are potentially key contributors to EV in AD patients, and this may extend to other viral infections afflicting this population.

Eczema herpeticum in a child in the first year of life: a clinical case report

This article describes up-to-date information about aetiology and pathogenesis of course of herpetic eczema. The authors highlighted new approaches to diagnosis and therapy of Kaposi varicelliform eruption in children of early age. It was described the results of own observations of the child in the first year of life with Kaposi varicelliform eruption and experience of application-sorption therapy in the treatment of this disease. The high efficiency of application-sorption therapy in skin lesions caused by combination of infection and allergy in children was noted. The clinical case examined allowed to assess the full complexity of differential diagnostic approaches in verification of eczema herpeticum. For a wide range of paediatricians and surgeons, algorithms for diagnosis and therapeutic tactics were described in the case of Kaposi varicelliform eruption.

Eczema Herpeticum in a Patient With Hailey-Hailey Disease Confounded by Coexistent Psoriasis

Eczema Herpeticum in a Patient With Hailey-Hailey Disease Confounded by Coexistent Psoriasis

Frequency and Clinical Features Associated With Eczema Herpeticum in Hospitalized Children With Presumed Atopic Dermatitis Skin Infection.

Atopic dermatitis (AD) predisposes to viral skin infections, such as eczema herpeticum (EH), and to bacterial skin infections, such as those caused by Staphylococcus aureus (SA) and group A streptococcus (GAS). This study evaluated clinical features of EH and its frequency of codetection with SA or GAS in children hospitalized for presumed AD skin infection. We retrospectively reviewed clinical data for children ≤18 years of age admitted to a large hospital system for AD with presumed skin infection from January 2004 to December 2018. Those with an alternate primary diagnosis or missing microbiologic data were excluded. Encounters with herpes simplex virus testing were identified as AD with EH (ADEH+) or without (ADEH-). Encounters with bacterial skin culture growth were identified as SA or GAS. Among 180 AD encounters with suspected skin infection, 133 (74%) were tested for herpes simplex virus. Clinical findings associated with ADEH+ status (n = 61) included fever on admission (59% vs. 32% in ADEH-; P = 0.002), rash on the neck (30% vs. 13%; P = 0.015) and vesicular rash (70% vs. 49%; P = 0.011). Encounters in the ADEH+ group had a longer hospital length of stay compared with encounters in the ADEH- group [median 4 days (interquartile range 3-5 days) vs. 3 days (interquartile range 2-3 days); P < 0.001]. GAS was identified in only 1 ADEH+ encounter (2%) versus 15 ADEH- encounters (26%), P < 0.001. Providers should maintain a high index of suspicion for EH in children admitted for presumed AD skin infection. GAS was more commonly associated with ADEH- encounters.

Automatic diagnosis of skin diseases using convolution neural network

Skin diseases are becoming a most common health issues among all the countries worldwide. The method proposed in this work detects four types of skin diseases using computer vision. The proposed approach involves Convolutional Neural Networks with specific focus on skin disease. The Convolutional Neural Network (CNN) used in this paper has utilized around 11 layers viz., Convolution Layer, Activation Layer, Pooling Layer, Fully Connected Layer and Soft-Max Classifier. Images from the DermNet database are used for validating the architecture. The database comprises all types of skin diseases out of which we have considered four different types of skin diseases like Acne, Keratosis, Eczema herpeticum, Urticaria with each class containing around 30 to 60 different samples. The challenges in automating the process includes the variation of skin tones, location of the disease, specifications of the image acquisition system etc., The proposed CNN Classifier results in an accuracy of 98.6% to 99.04%.

Staphylococcal Toxins in Atopic Dermatitis and Eczema Herpeticum

Staphylococcal Toxins in Atopic Dermatitis and Eczema Herpeticum

Association of Atopic Dermatitis With Bacterial, Fungal, Viral, and Sexually Transmitted Skin Infections.

Atopic dermatitis (AD) is associated with altered skin barrier, microbiome, and immune dysregulation that may increase risk of skin infections. The aim of the study was to determine whether AD is associated with skin infections and related outcomes. Data from the 2006 to 2012 National Emergency Department Sample were analyzed, including an approximately 20% sample of all US emergency department (ED) visits (N = 198,102,435 adults or children). Skin infections were increased in ED visits of adults (7.14% vs 3.76%) and children (5.15% vs 2.48%) with AD. In multivariable logistic regression models, AD was associated with significantly higher odds of skin infection in adults (adjusted odds ratio [95% confidence interval] = 1.93 [1.89-1.97]) and children (2.23 [2.16-2.31]). Pediatric and adult AD were associated with significantly higher odds of carbuncle/furuncles, impetigo, cellulitis, erysipelas, methicillin-resistant and methicillin-sensitive Staphylococcus aureus infections, molluscum contagiosum, cutaneous warts, herpes simplex and zoster viruses, eczema herpeticum, dermatophytosis, and candidiasis of skin/nails and vulva/urogenitals. Adults with AD had significantly higher odds of genital warts (1.51 [1.36-1.52]) and herpes (1.23 [1.11-1.35]). Skin infections were associated with US $19 million excess annual costs of ED care in persons with AD. Atopic dermatitis patients had higher odds of multiple bacterial, viral, fungal, and sexually transmitted skin infections.