From Itch to Emergency: Eczema Herpeticum Threat in Atopic Dermatitis Patients

Kılavuz G. Ü., Süleyman A., Dolu K. O., Karavaizoğlu Ç., Gürbüz S., Karakaya B., ...Daha Fazla

European Academy of Allergy and Clinical Immunology(EAACI) Annual Congress 2025, Glasgow, İngiltere, 13 - 16 Haziran 2025, (Yayınlanmadı)

  • Yayın Türü: Bildiri / Yayınlanmadı
  • Basıldığı Şehir: Glasgow
  • Basıldığı Ülke: İngiltere
  • İstanbul Üniversitesi Adresli: Evet

Özet

From Itch to Emergency: Eczema Herpeticum Threat in Atopic Dermatitis Patients

Background:

Atopic dermatitis (AD) is a common chronic, recurrent, itchy, and inflammatory skin disease in children. Secondary infections can occur in AD patients due to disrupted skin barriers. Eczema herpeticum (EH) frequently develops in AD patients through the dissemination of the herpes simplex virus. In our case series, we present the characteristics of EH-diagnosed patients with underlying AD, providing an overview of its diagnosis and treatment.

Methods:


The study included 8 cases diagnosed with EH, followed at Istanbul University Istanbul Faculty of Medicine, Division of Pediatric Immunology and Allergy, between January 2018 and January 2025. Demographic and clinical features, as well as follow-up and treatment details, were retrospectively evaluated. Consents were obtained from the patients' guardians.

Results:


All cases were diagnosed with AD, including 3 females and 5 males, with a mean age of 6 years (± 4.2 SDS). Assessment of atopic dermatitis severity using the SCORAD index revealed a mean score of (75.9± 0,50 SDS), categorizing all cases as severe AD. Vesiculopapular and pustular lesions with hemorrhagic crusts compatible with eczema herpeticum findings were localized to the face in 2 cases, involved the extremities, face, and trunk in 4 cases, were confined to the neck in 1 case, and affected both the face and extremities in 1 case. A history of herpes labialis was detected in only 2 families. Clinical diagnoses were also confirmed in 2 cases by HSV-1 DNA. All cases received acyclovir treatment, none of them had keratoconjunctivitis. All cases had early-onset AD begining in infancy and topical calcineurin inhibitor had been used in one patient. Four cases experienced recurrent episodes, and one case presented with encephalopathy during hospitalization. Seven cases showed no complications. Genetic testing was recommended for all patients. 

Conclusion:

Although eczema herpeticum affects approximately 3% of children with AD, EH can be life-threatening if untreated or complicated, necessitating urgent management. It should be considered in the differential diagnosis in acute flares of AD.