Immunological Studies of herpes simplex virus infection in children with atopic eczema

Abstract

This study examines the role of immune defence mechanisms in herpes simplex virus (HSV) infections in atopic eczema and whether impairment of these mechanisms explains the susceptibility of some children with atopic eczema to cutaneous HSV infections. Ten children with eczema herpeticum and 13 with atopic eczema and recurrent HSV infection affecting multiple skin sites were studied, together with relevant control groups. In all children with atopic eczema, in vitro lymphoproliferation in response to stimulation with concanavalin A (Con A) was significantly decreased and natural killer (NK) cells (CD16 + 56) were reduced compared with non-atopic controls. IL-2 receptors, a marker for lymphocyte activation, were decreased during the acute phase of eczema herpeticum, and for 1 month thereafter. A positive stimulation index (> 3) to HSV antigen, and high HSV IgG antibody titres measured by ELISA, Western blotting and neutralization assay, were seen in children with eczema herpeticum by 6 weeks, and also in children with atopic eczema and recurrent HSV infections. No evidence of an HSV-specific immune defect (either cell-mediated or humoral) was found in atopic eczema. Impairment of cell-mediated immunity in atopic eczema was suggested by the reduced response to Con A. It is likely that reduced numbers of circulating NK cells and a decrease in IL-2 receptors during early eczema herpeticum contribute to the susceptibility of children with atopic eczema to cutaneous HSV infections.

Increased incidence of skin infections in atopy: evidence for an antigen‐specific homing defect?

“…Alternatively, a more general defect in cell‐mediated immunity as observed in children with eczema herpeticatum [41] and in atopic dermatitis may contribute [42]. In this work, reduced proliferation in response to Con A [41], PPD and HSV [42] has been observed. Deficient IFN‐γ production potentially caused by diminished IL‐12 and/or IL‐2 concentration during priming [43] may be of additional importance.…”

“…The impaired immune response associated with IH could be explained, in part, by reduced cytolytic potential of human Th2 cells as compared with Th1 cells by virtue of their associated cytokines [40]. Alternatively, a more general defect in cell‐mediated immunity as observed in children with eczema herpeticatum [41] and in atopic dermatitis may contribute [42]. In this work, reduced proliferation in response to Con A [41], PPD and HSV [42] has been observed.…”

Eczema Herpeticum Localized to Area of Tinea Cruris

“…The pre‐existing dermatoses complicated by EH include atopic dermatitis (1), Darier's disease (7, 8), pemphigus foliaceus (9), seborrheic dermatitis (10), Wiskott‐Aldrich syndrome (10), ichthyosis vulgaris (11), benign familial pemphigus (12), mycosis fungoides (13), autologous skin grafting (4), irritant contact dermatitis (14), thermal burns (15), and staphylococcal scalded skin syndrome (16).…”

“…Patients with EH may have impairment of cell‐mediated immunity (1), alteration of epidermal barrier function (14–16) or both (16). Our patient had a groin lesion with Trichophyton rubrum species of dermatophyte.…”

“…Eczema herpeticum (EH), or Kaposi's varicelliform eruption (KVE) due to herpes simplex virus (HSV), is characterized by widespread or localized vesicopustules that occur in a patient with a pre‐existing skin disease (1–5). Most cases occur with atopic dermatitis, but it may be associated with other dermatoses (2).…”