Email this article Clinical and anamnestic criteria for early diagnosis of herpetic eczema in children with atopic dermatitis
- Authors: Stadnikova A.S.1, Tamrazova O.B.1,2, Chebotareva T.A.3
-
Affiliations:
- Bashlyaeva Children's City Clinical Hospital
- People's Friendship University of Russia (RUDN University)
- Russian Medical Academy of Continuing Professional Education
- Issue: Vol 46, No 2 (2018)
- Pages: 126-131
- Section: ARTICLES
- URL: https://almclinmed.ru/jour/article/view/792
- DOI: https://doi.org/10.18786/2072-0505-2018-46-2-126-131
- ID: 792
Cite item
Full Text
Abstract
Rationale: Herpetic eczema (HE), being one of manifestations of generalized Herpes simplex virus (HSV) infection, presents mostly as a complication of atopic dermatitis (AD). This is a potentially life-threatening infection with mortality rates of up to 9%. Early diagnosis and timely beginning of antiviral treatment may help to avoid severe complications and mortality in children with HE.
Aim: To evaluate factors predisposing to the development of HE in children with AD and to identify a high risk group.
Materials and methods: One hundred and fifty (150) children with AD aged from 4 months to 18 years were recruited into this one-center prospective stratified observational study. The main group included 113 children with HE with underlying AD, while the comparison group comprised 37 children with AD exacerbations without HE. HSV infection was confirmed by determination of the viral DNA in blood by polymerase chain reaction. The severity of AD at study entry and during follow up was assessed with SCORAD scale.
Results: All children with HE + AD (100%) had been in contact with individuals with clinical manifestations of HSV infection (35.1% in the comparison group, p < 0.001). The main predictors of HE in AD patients were as follows: age below 1 year (relative risk increase (RRI) 2.86, 95% confidence interval (CI) -7.91 / -0.68, p < 0.001), autumn and winter season (RRI 1.68, 95% CI -5.3 / -0.15, p = 0.018), moderate and severe AD (RRI 0.91, 95% CI -2.11 / -0.17, p < 0.002).
Conclusion: A combination of 3 risk factors, such as age below 1 year, autumn and winter season, moderate and severe AD, puts a patient into a high risk of HE. Children from the risk group should be isolated from patients with manifest HSV infection.
Keywords
About the authors
A. S. Stadnikova
Bashlyaeva Children's City Clinical Hospital
Author for correspondence.
Email: tonya-st@yandex.ru
Antonina S. Stadnikova – MD, Dermatovenereologist, General Clinic Department.
28 Geroev Panfilovtsev ul., Moscow, 125373, tel.: +7 (495) 496 74 90
Russian FederationO. B. Tamrazova
Bashlyaeva Children's City Clinical Hospital; People's Friendship University of Russia (RUDN University)
Email: fake@neicon.ru
Ol'ga B. Tamrazova – MD, PhD, Professor, Consultant Physician Bashlyaeva CCCH; Chair of Dermatovenereology, Postgraduate Medical Training Faculty RUDN University.
28 Geroev Panfilovtsev ul., Moscow, 125373; 6 Miklukho-Maklaya ul., Moscow, 117198
Russian FederationT. A. Chebotareva
Russian Medical Academy of Continuing Professional Education
Email: fake@neicon.ru
Tat'yana A. Chebotareva – MD, PhD, Associate Professor, Chair of Pediatric Infectious Diseases.
2/1–1 Barrikadnaya ul., Moscow, 125993
Russian FederationReferences
- Beck LA, Boguniewicz M, Hata T, Schneider LC, Hanifin J, Gallo R, Paller AS, Lieff S, Reese J, Zaccaro D, Milgrom H, Barnes KC, Leung DY. Phenotype of atopic dermatitis subjects with a history of eczema herpeticum. J Allergy Clin Immunol. 2009;124(2): 260–9.e1–7. doi: 10.1016/j.jaci.2009.05.020.
- Белоусова ТА, Горячкина МВ. Простой герпес: клинико-терапевтические аспекты. Медицинский вестник. Портал российского врача. 2014;(4) [Электронный ресурс]. Доступно на: https://lib.medvestnik.ru/articles/Prostoi-gerpes-kliniko-terapevticheskie-aspekty.html.
- Mooney MA, Janniger CK, Schwartz RA. Kaposi's varicelliform eruption. Cutis. 1994;53(5): 243–5.
- Aronson PL, Yan AC, Mittal MK, Mohamad Z, Shah SS. Delayed acyclovir and outcomes of children hospitalized with eczema herpeticum. Pediatrics. 2011;128(6): 1161–7. doi: 10.1542/peds.2011-0948.
- Fitzpatrick JE, Aeling JL. Dermatology Secrets in Color. 2nd ed. Philadelphia: Hanley & Belfus; 2001. 498 p.
- Atherton DJ, Marshall WC. Eczema herpeticum. Practitioner. 1982;226(1367): 971–3.
- Wollenberg A. Eczema herpeticum. Chem Immunol Allergy. 2012;96:89–95. doi: 10.1159/000331892.
- Hsu DY, Shinkai K, Silverberg JI. Epidemiology of Eczema Herpeticum in Hospitalized U.S. Children: Analysis of a Nationwide Cohort. J Invest Dermatol. 2018;138(2): 265–72. doi: 10.1016/j.jid.2017.08.039.
- Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology. 1993;186(1): 23–31. doi: 10.1159/000247298.
- Сергеева КМ. Педиатрия: учебник. СПб.: Питер; 2007. 544 с.
- Ревякина ВА, Огородова ЛМ, Деев ИА, Петровский ФИ, Бычковская СВ, Голосова ТГ, Казакевич НВ, Коростовцев ДС, Липина ВР, Сидоренко ИВ, Смирнов НА, Черняк БА, Деева ЕВ. Результаты национального многоцентрового клинико-эпидемиологического исследования атопического дерматита у детей. Аллергология. 2006;(1): 3–9.
- Тамразова ОБ, Мазанкова ЛН, Корсунская ИМ, Павлова ЛА. Герпетическая экзема у детей: методические рекомендации. М.; 2007. 23 c.
- Ющук НД, Венгеров ЮЯ, ред. Инфекционные болезни: национальное руководство. М.: ГЭОТАР-Медиа; 2015. 1056 с.
- Сергеев ЮВ, ред. Атопический дерматит: новые подходы к профилактике и наружной терапии. Рекомендации для врачей. 2-е изд. М.: Медицина для всех; 2005. 64 с.
- Moran PJ, Geoghegan P, Sexton DJ, O'Regan A. A skin rash to remember. BMJ. 2012;345:e6625. doi: 10.1136/bmj.e6625.
Supplementary files
