aard Allergy, Asthma & Respiratory Disease Allergy Asthma Respir Dis 2288-0402 2288-0410 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma 10.4168/aard.2018.6.3.174 aard-6-174 Original Article Clinical features of eczema herpeticum in atopic dermatitis in a single center JangHyun Ji 1 RhoYoung Eun 1 KimKwanghoon 1 KimSeong Heon 2 KimYoung Mi 1 KimHye-Young 1 Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea Correspondence to: Hye-Young Kim https://orcid.org/0000-0001-7125-8840 Department of Pediatrics, Pusan National University Hospital, Pusan National University College of Medicine, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea Tel: +82-51-240-7298, Fax: +82-51-248-6205, E-mail: pearlhy@naver.com

• This study was supported by clinical research grant from Pusan National University Hospital in 2016.

 52018 552018 63 174178 31102017 13022018 28022018 Copyright © 2018 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma 2018 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose

This study evaluated the clinical characteristics and risk factors associated with atopic dermatitis patients complicated by eczema herpeticum.

 Methods

This study included 45 patients under the age of 18 with atopic dermatitis complicated by eczema herpeticum in the disease group (ADEH+), and 50 patients under the age of 18 with atopic dermatitis without any episode of eczema herpeticum in the control group (ADEH–). We retrospectively reviewed the clinical features, treatment and prognosis of the 2 groups.

 Results

In this study, eczema herpeticum occurred in 2.7% of the AD patients. No significant difference in percentage of boys or mean age was found between the ADEH+ and ADEH– groups. In the ADEH+ group, eczema herpeticum occurred more frequently in the head and neck. Severe atopic dermatitis, recurrent impetigo, IgE–mediated atopic dermatitis and food allergy were identified as the risk factors of eczema herpeticum. The mean white blood cell count, erythrocyte sedimentation rate, percent of eosinophils and total serum IgE were higher in the ADEH+ group than in the ADEH– group. More than 2 recurrences were confirmed in 12 patients (26.7%).

 Conclusion

In the ADEH+ group, skin lesions were dominant on the head and neck. We revealed that severe atopic dermatitis, frequent impetigo, IgE-mediated atopic dermatitis, and food allergy are risk factors for eczema herpeticum.

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Comparison of laboratory data between ADEH+ and ADEH– groups. White blood cell (WBC) count (A), erythrocyte sedimentation rate (ESR) (B), percent of eosinophils (C), and serum total IgE level (D). AD, atopic dermatitis; ADEH+, AD patients with one or more episodes of AD complicated by eczema herpeticum (ADEH); ADEH–, AD patients without any episode of ADEH. ∗ P<0.05.

Difference of clinical characteristics between ADEH+ and ADEH- groups

Characteristic ADEH+ (n=45) ADEH- (n=50) P-value
Male sex 30 (66.7) 31 (62.0) 0.781
Age (yr) 4.1±3.7 4.5±2.3 0.854
Distribution of age (yr)     0.122
 ≤5 25 (55.6) 24 (48.0)  
 6–10 11 (24.4) 15 (30.0)  
 11–15 7 (15.6) 8 (16.0)  
 ≥16 2 (4.4) 3 (6.0)  
Age at diagnosis of AD (mo)     0.087
 <12 34 (75.6) 30 (60.0)  
 ≥12 11 (24.4) 20 (40.0)  
No. of history of impetigo 7.8±1.2 2.3±0.5 0.020
History of food allergy 21 (46.7) 10 (20.0) 0.012
SCORAD index     0.031
 Severe (≥45) 22 (48.9) 10 (20.0)  
 Moderate (15–45) 18 (40.0) 20 (40.0)  
 Mild (<15) 5 (11.1) 20 (40.0)  

Values are presented as number (%) or mean±standard deviation.

ADEH+, AD patients with one or more episodes of AD complicated by eczema herpeticum (ADEH); ADEH–, AD patients without any episode of ADEH; AD, atopic dermatitis; SCORAD, SCORing Atopic Dermatitis.

Difference of sensitization between ADEH+ and ADEH– groups

Variable A ADEH+ (n=45) ADEH- (n=50) P-value
Type of atopic dermatitis     0.011
 IgE mediated AD 38 (84.4) 27 (54.0)  
 Non-IgE mediated AD 7 (15.6) 23 (46.0)  
Inhalant allergen sensitization 20 (44.4) 7 (14.0) 0.009
 Dermatophagoides pteronissinus 18 (40.0) 7 (14.0) 0.016
 Dermatophagoides farina 16 (35.6) 5 (10.0) 0.008
Food allergen sensitization 37 (82.2) 25 (50.0) 0.037
 Egg white 25 (55.6) 12 (24.0) 0.021
 Cow milk 15 (33.3) 6 (12.0) 0.049
 Peanut 7 (15.6) 3 (6.0) 0.037
 Soy bean 3 (6.7) 1 (2.0) NA
 Wheat 3 (6.7) 1 (2.0) NA
 Walnut 5 (11.1) 1 (2.0) NA
 Shrimp 0 (0) 0 (0) NA
 Buckwheat 1 (2.2) 0 (0) NA

Values are presented as number (%).

ADEH+, AD patients with one or more episodes of AD complicated by eczema herpeticum (ADEH); ADEH–, AD patients without any episode of ADEH; AD, atopic dermatitis; NA, not available.

Clinical manifestations and prognosis of ADEH+ group (n=45)

Variable Value
Distribution area  
 Head and neck 21 (46.7)
 Whole body 12 (26.6)
 Trunk 8 (17.8)
 Arm and leg 4 (8.9)
Associated symptoms  
 Lymphadenitis 14 (31.1)
 Fever 8 (17.8)
Hospitalization period (day) 5.7±1.7
Recurrence of eczema herpeticum 12 (26.7)

Values are presented as number (%) or mean±standard deviation.

ADEH+, AD patients with one or more episodes of AD complicated by eczema herpeticum; AD, atopic dermatitis.