Eczema Herpeticum: Clinical and Pathophysiological Aspects

Area of Science:

• Dermatology
• Immunology
• Virology

Background:

• Atopic dermatitis (AD) is a prevalent chronic inflammatory skin condition.
• AD involves skin barrier defects, immune dysregulation, and altered skin microbiota.
• Patients with AD have an increased susceptibility to infections, including viral ones.

Purpose of the Study:

• To review the clinical aspects, diagnosis, and treatment of eczema herpeticum (EH).
• To elucidate the pathophysiology and predisposing factors for herpetic complications in AD patients.
• To consolidate current knowledge on EH in the context of atopic dermatitis.

Main Methods:

• Literature review focusing on clinical features, diagnosis, treatment, and pathophysiology of EH in AD.
• Analysis of predisposing factors including skin barrier impairment, immune cell dysfunction, and genetic elements.
• Examination of the role of skin microbiota and microbial factors in EH development.

Main Results:

• EH, a severe HSV infection, affects approximately 3% of AD patients.
• Predisposing factors include filaggrin deficits, junctional anomalies, reduced antimicrobial peptides, cytokine imbalances (IL-4, IL-13, IL-25, IL-33, TSLP), impaired interferon responses, and immune cell defects.
• Genetic polymorphisms, topical calcineurin inhibitors, and Staphylococcus aureus colonization/toxin production in AD contribute to EH risk.

Conclusions:

• Skin barrier dysfunction, immune dysregulation, and microbial imbalance are critical in EH pathogenesis in AD.
• Understanding these factors is crucial for managing and preventing severe herpetic infections in AD patients.
• Further research into these complex interactions may reveal novel therapeutic targets.