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Herpes simplex infections in atopic eczema
Insights
Herpes simplex infections are common in children with atopic eczema. Early virological diagnosis aids in managing these symptomatic infections, which can include severe recurrences.
Area of Science:
- Pediatric Dermatology
- Infectious Diseases
- Immunology
Background:
- Atopic eczema is a common chronic inflammatory skin condition in children.
- Children with atopic eczema are susceptible to secondary infections, including herpes simplex virus (HSV).
- The clinical presentation of HSV in atopic eczema can be severe and atypical.
Purpose of the Study:
- To prospectively investigate the incidence and characteristics of symptomatic herpes simplex infections in children with atopic eczema.
- To evaluate the clinical course, recurrence patterns, and diagnostic methods for HSV in this patient population.
Main Methods:
- Prospective study of 179 children with atopic eczema over a mean observation period of 18 months.
- Clinical monitoring for herpes simplex infections, including vesicle formation and response to treatment.
- Virological investigations such as electron microscopy and viral cultures were utilized for rapid diagnosis.
Main Results:
- Symptomatic herpes simplex infections were observed in a subset of children with atopic eczema.
- Recurrences of herpes simplex infection occurred in five patients, with some experiencing severe episodes.
- Topical corticosteroid use preceded only a small fraction of the herpes simplex episodes.
- Virological investigations proved to be rapid and effective for diagnosis.
Conclusions:
- Symptomatic herpes simplex infections are a significant concern in children with atopic eczema.
- The presence of vesicles or antibiotic-resistant eczematous lesions should prompt consideration of HSV infection.
- Prompt virological diagnosis is crucial for appropriate management and treatment of HSV in this vulnerable group.
Abstract:
One hundred and seventy nine children with atopic eczema were studied prospectively for two and three quarter years; the mean period of observation being 18 months. Ten children had initial infections with herpes simplex. Four children, very ill with a persistently high fever despite intravenous antibiotics and rectal aspirin, continued to produce vesicles and were given intravenous acyclovir. There were 11 recurrences among five patients. In two patients the recurrences were as severe as the initial lesions, and one of these children had IgG2 deficiency. Use of topical corticosteroids preceded the episode of herpes in only three of the 21 episodes. Symptomatic herpes simplex infections are common in children with atopic eczema, and are suggested by the presence of vesicles or by infected eczema which does not respond to antibiotic treatment. Virological investigations are simple and rapid: electron microscopy takes minutes, and cultures are often positive within 24 hours.