Clinical and anamnestic criteria for early diagnosis of herpetic eczema in children with atopic dermatitis

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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.

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 Federation

O. 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 Federation

T. 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 Federation

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Copyright (c) 2018 Stadnikova A.S., Tamrazova O.B., Chebotareva T.A.

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