Increasing incidence of eczema herpeticum: Analysis of seventy-five cases

Safety and Efficacy of 1 Year of Tacrolimus Ointment Monotherapy in Adults With Atopic Dermatitis

“…22 Because cell-mediated immunity is critical for protection against recurrent viral infections, it has been proposed that the compromised cellmediated immunity in patients with atopic dermatitis is responsible for their increased susceptibility to viral superinfections of the skin and the frequent recurrence of lower-grade viral skin infections. 23 Compared with the incidence of eczema herpeticum demonstrated in a survey 24 conducted at a single university clinic, which showed an incidence of approximately 12 patients per year from 1982 to 1986, the incidence observed in the present study (6 patients) is not remarkable.…”

Eczema herpeticum during Treatment of Atopic Dermatitis with 0.1% Tacrolimus Ointment

“…Among 316 patients treated for 6–12 months, the authors report 6 cases (2%) of eczema herpeticum [6]. Interestingly, there were 41 cases (13%) of herpes simplex lesions, which is consistent with the notion that patients with atopic dermatitis may experience frequent recurrences of herpes simplex without getting eczema herpeticum [9, 10]. Two previous studies on short-time clinical efficacy of topical tacrolimus therapy have only reported one unspecified viral infection [4, 5].…”

“…The disease has been observed in 6% of 179 children with severe atopic dermatitis [11]and in less than 3% of 492 patients with atopic dermatitis [12]. Surveys from Europe and Japan have reported an up to fivefold increase in the incidence of eczema herpeticum in recent years [10, 13]. In conclusion, the number of cases of eczema herpeticum observed during treatment with tacrolimus ointment and reported in the literature does not seem to exceed the expected incidence in patients with atopic dermatitis.…”

“…Classically considered to be a disease of infancy, and an equivalent of a primary infection with the HSV-1, recent data suggest that eczema herpeticum frequently occurs as a recurrent-type infection in young adults suffering from atopic dermatitis [10, 14]. Theoretically, asymptomatic oral HSV-1 shedding might be a source of reinfection in these patients, but available data are not conclusive [14].…”

“…On the other hand, the absence of anti-HSV antibodies might be a predisposing factor for the development of eczema herpeticum in the setting of a primoinfection in a patient with atopic dermatitis. It has been speculated that the decline of the prevalence of anti-HSV antibodies in young persons observed in Japan might be a factor in the massive increase in the incidence of eczema herpeticum, that has been observed in Japan and in Europe as well [10, 13]. However, these data might simply reflect the increasing prevalence of atopic dermatitis.…”