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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

200 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


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

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology


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