Clinical features of eczema herpeticum in atopic dermatitis in a single center

Hyun Ji Jang; Young Eun Rho; Kwanghoon Kim; Seong Heon Kim; Young Mi Kim; Hye-Young Kim

doi:10.4168/aard.2018.6.3.174

Journal List > Allergy Asthma Respir Dis > v.6(3) > 1095181

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Jang, Rho, Kim, Kim, Kim, and Kim: Clinical features of eczema herpeticum in atopic dermatitis in a single center

Original Article

Allergy Asthma Respir Dis 2018;6(3):174-178.

Published online: 5 May 2018

DOI: https://doi.org/10.4168/aard.2018.6.3.174

Clinical features of eczema herpeticum in atopic dermatitis in a single center

Hyun Ji Jang¹, Young Eun Rho¹, Kwanghoon Kim¹, Seong Heon Kim², Young Mi Kim¹, Hye-Young Kim¹

¹Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea

²Department 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.

Received 31 October 201713 February 2018 Accepted 28 February 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.

Abstract

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.

Keywords: Atopic dermatitis, Eczema herpeticum, Herpes simplex virus, Child, Risk factor

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Fig. 1.

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.

Table 1.

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.

Table 2.

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.

Table 3.

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.

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