Phenotype of atopic dermatitis subjects with a history of eczema herpeticum

Lisa A. Beck, Mark Boguniewicz, Tissa Hata, Lynda C. Schneider, Jon Hanifin, Rich Gallo, Amy S. Paller, Susi Lieff, Jamie Reese, Daniel Zaccaro, Henry Milgrom, Kathleen C. Barnes, Donald Y.M. Leung

Research output: Contribution to journalArticlepeer-review

223 Scopus citations


Background: A subset of subjects with atopic dermatitis (AD) are susceptible to serious infections with herpes simplex virus, called eczema herpeticum, or vaccina virus, called eczema vaccinatum. Objective: This National Institute of Allergy and Infectious Diseases-funded multicenter study was performed to establish a database of clinical information and biologic samples on subjects with AD with and without a history of eczema herpeticum (ADEH+ and ADEH- subjects, respectively) and healthy control subjects. Careful phenotyping of AD subsets might suggest mechanisms responsible for disseminated viral infections and help identify at-risk individuals. Methods: We analyzed the data from 901 subjects (ADEH+ subjects, n = 134; ADEH- subjects, n = 419; healthy control subjects, n = 348) enrolled between May 11, 2006, and September 16, 2008, at 7 US medical centers. Results: ADEH+ subjects had more severe disease based on scoring systems (Eczema Area and Severity Index and Rajka-Langeland score), body surface area affected, and biomarkers (circulating eosinophil counts and serum IgE, thymus and activation-regulated chemokine, and cutaneous T cell-attracting chemokine) than ADEH- subjects (P < .001). ADEH+ subjects were also more likely to have a history of food allergy (69% vs 40%, P < .001) or asthma (64% vs 44%, P < .001) and were more commonly sensitized to many common allergens (P < .001). Cutaneous infections with Staphylococcus aureus or molluscum contagiosum virus were more common in ADEH+ subjects (78% and 8%, respectively) than in ADEH- subjects (29% and 2%, respectively; P < .001). Conclusion: Subjects with AD in whom eczema herpeticum develops have more severe TH2-polarized disease with greater allergen sensitization and more commonly have a history of food allergy, asthma, or both. They are also much more likely to experience cutaneous infections with S aureus or molluscum contagiosum.

Original languageEnglish (US)
Pages (from-to)260-269.e7
JournalJournal of Allergy and Clinical Immunology
Issue number2
StatePublished - Aug 2009
Externally publishedYes


  • Atopic dermatitis
  • Staphylococcus aureus
  • biomarkers
  • eczema herpeticum
  • eczema vaccinatum
  • herpes simplex virus

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology


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