J Invest Dermatol 2018 Jun 2. Epub 2018 Jun 2.

Department of Dermatology, Fukuoka University Faculty of Medicine, Fukuoka, Japan; Department of Dermatology, Fukuoka University Hospital, Fukuoka, Japan.

Destruction of epidermal barrier function associated with atopic dermatitis or Darier's disease often causes severe secondary skin infections. Patients with skin barrier disorders often repeatedly acquire Kaposi varicelliform eruption, which is caused by herpes simplex virus, but the underlying mechanisms and effective preventive methods have yet to be found. Viral infection through an impaired epidermal barrier can be prevented by enhancing innate immunity and/or inhibiting viral entry. Read More

Clin Exp Dermatol 2018 Feb 15. Epub 2018 Feb 15.

Department of Dermatology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.

Pediatr Dermatol 2017 Nov;34(6):686-689

Saint Louis University Hospital, St. Louis, MO, USA.

Background/objectives: Interferon gamma (IFN-γ) has been used treat severe atopic dermatitis, with equivocal results. Recurrent eczema herpeticum is an underappreciated, therapeutically challenging complication of severe atopic dermatitis. Defects in IFN-γ and other cytokine pathways have been identified in individuals with confirmed eczema herpeticum. Read More

J Emerg Med 2017 Sep;53(3):412-413

Department of Emergency Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas.

N Engl J Med 2017 Aug;377(7):e9

University of Catania, Catania, Italy

Vaccine 2017 07 20;35(33):4245-4254. Epub 2017 Jun 20.

Department of Infectious Diseases, Israel Institute for Biological Research (IIBR), Ness-Ziona, Israel. Electronic address:

Eczema vaccinatum is a severe and occasionally lethal complication of smallpox vaccine, characterized by systemic viral dissemination, distant from the initial inoculation site of the vaccine. A major risk factor for eczema vaccinatum is a background of atopic dermatitis, a chronic, common allergic, relapsing disorder, manifested by dry and inflamed skin, itchy rash, Th2 biased immune response and hypersensitivity to various antigens. Unlike the severe manifestations of eczema vaccinatum in humans, current models present only mild symptoms that limits examination of potential therapeutics for eczema vaccinatum. Read More

Dtsch Med Wochenschr 2017 May 17;142(10):721-722. Epub 2017 May 17.

J Immunol 2017 06 3;198(11):4341-4351. Epub 2017 May 3.

Pediatric Rheumatology, University of Colorado-Denver, Aurora, CO 80045

The IL-1 superfamily of cytokines and receptors has been studied extensively. However, the specific roles of IL-1 elements in host immunity to cutaneous viral infection remain elusive. In this study, we applied vaccinia virus (VACV) by scarification to IL-1R1 knockout mice (IL-1R1) and found that these mice developed markedly larger lesions with higher viral genome copies in skin than did wild-type mice. Read More

CMAJ 2017 04;189(13):E505

Department of Internal Medicine (Kim), Englewood Hospital and Medical Center, Englewood, NJ; Department of Hospital Medicine (Hohmuth), Geisinger Medical Center, Danville, Penn.

Ann Dermatol Venereol 2017 Mar 24;144(3):176-181. Epub 2017 Feb 24.

Service de dermatologie, hôpital Cochin, université Paris Descartes, Assistance publique-Hôpitaux de Paris (AP-HP), pavillon Tarnier, 89, rue d'Assas, 75006 Paris, France. Electronic address:

Background: Although varicelliform Kaposi eruption is a well-known complication of dermatoses, it has not been widely investigated.

Aim: To investigate features of dermatoses and herpes superinfection in patients hospitalized in a dermatology department.

Patients And Methods: We performed a single-centre, retrospective study between 2008 and 2014 that included cases of Kaposi varicelliform eruptions defined by positive PCR of an unconventional site of herpetic recurrence in a setting of active dermatitis. Read More

Immunol Allergy Clin North Am 2017 02;37(1):75-93

Department of Pediatrics, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA; Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS 75, Los Angeles, CA 90027, USA. Electronic address:

Atopic dermatitis is characterized by the interplay of skin barrier defects with the immune system and skin microbiome that causes patients to be at risk for infectious complications. This article reviews the pathogenesis of atopic dermatitis and the mechanisms through which patients are at risk for infection from bacterial, viral, and fungal pathogens. Although these complications may be managed acutely, prevention of secondary infections depends on a multipronged approach in the maintenance of skin integrity, control of flares, and microbial pathogens. Read More

Case Rep Obstet Gynecol 2016 20;2016:5319425. Epub 2016 Oct 20.

Department of Obstetrics and Gynecology, Detroit Medical Center, Wayne State University, 3990 John R., 7 Brush N., Detroit, MI 48201, USA.

Kaposi varicelliform eruption (KVE) is a widespread cutaneous viral infection, most commonly herpes simplex virus, which affects patients with underlying dermatosis. When KVE occurs in a patient with a history of psoriasis, it is referred to as psoriasis herpeticum, a rare subtype of KVE with only a handful of cases reported in the literature. To the authors' knowledge, we report for the first time a case of psoriasis herpeticum in pregnancy. Read More

J Fr Ophtalmol 2016 Nov 13;39(9):e247-e248. Epub 2016 Oct 13.

Cabinet privé, avenue Omar-Ibn-Al-Khattab, 10000 Rabat, Maroc.

J Fam Pract 2016 Jul;65(7):E1-3

University of Texas Health Science Center at San Antonio, TX, USA.

A bath with scented soap prompted a flare of the boy's eczema. Days later, he was hospitalized with diffuse erosions covering 90% of his body. What was the cause? Read More

J Allergy Clin Immunol 2017 Mar 29;139(3):997-1006.e10. Epub 2016 Jul 29.

Division of Cell Biology, La Jolla Institute for Allergy and Immunology, La Jolla, Calif; Laboratory for Allergic Disease, RIKEN Center for Integrative Medical Sciences (IMS), Yokohama, Japan. Electronic address:

Background: Patients with atopic dermatitis (AD) are susceptible to several viruses, including herpes simplex virus (HSV). Some patients experience 1 or more episodes of a severe skin infection caused by HSV termed eczema herpeticum (EH). There are numerous mouse models of AD, but no established model exists for EH. Read More

Medicine (Baltimore) 2016 Jul;95(29):e4284

aDepartment of Dermatovenereology, West China Hospital, Sichuan University bDepartment of Diagnostic Ultrasound, Second University Hospital of Sichuan University cDepartment of Lab Medicine dDepartment of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.

Background: Eczema herpeticum is a rare, severe, and disseminated infection of herpes simplex virus in the setting of eczematous skin diseases.

Methods: We experienced a case of this disease in a 9-month-old infant characterized by a sudden onset of monomorphic vesicles on the head, right lower leg, and two hands. The infant has a 7-month history of atopic dermatitis and his condition was initially regarded as a complication of atopic dermatitis and bacterial infection. Read More

Am J Crit Care 2016 Jul;25(4):379-82

Christina L. Tupe is a clinical instructor, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland. Bethany A. Weiler is a pulmonary critical care fellow and Avelino C. Verceles is an assistant professor, Division of Pulmonary, Critical Care and Sleep Medicine, University of Maryland School of Medicine. Michael T. McCurdy is an assistant professor, Department of Emergency Medicine and Critical Care, University of Maryland School of Medicine.

A 62-year-old woman treated with several courses of corticosteroids for an undifferentiated rash came to the emergency department with progressively worsening cutaneous signs and symptoms and generalized weakness. She had scabies, and despite treatment continued to decompensate. Repeat skin biopsies revealed disseminated herpes simplex virus infection, and results of blood cultures were consistent with infection by methicillin-resistant Staphylococcus aureus. Read More

JAAD Case Rep 2016 May 25;2(3):209-11. Epub 2016 May 25.

Department of Dermatology, University Hospital, Brest, France.

Actas Dermosifiliogr 2017 Jan - Feb;108(1):68. Epub 2016 Mar 19.

Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen de las Nieves, Granada, España.

Minerva Pediatr 2016 Feb;68(1):72-3

Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, Istanbul Medical Faculty, Istanbul, Turkey -

Br J Dermatol 2016 Jul 19;175(1):220-2. Epub 2016 Apr 19.

Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, U.S.A.

Acta Dermatovenerol Croat 2015 ;23(4):298-300

Prof. Furen Zhang, MD, PhD, Shandong Provincial Institute of Dermatology and Venereology, 27397 Jingshi Road, Jinan, Shandong Province, 250022, China;

Intern Emerg Med 2016 Sep 25;11(6):885-7. Epub 2015 Nov 25.

Department of General Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.

Indian Dermatol Online J 2015 Sep-Oct;6(5):364-6

Department of Skin and VD, Shree Krishna Hospital, Karamsad, Gujarat, India.

Int J Dermatol 2016 Mar 24;55(3):e136-40. Epub 2015 Oct 24.

Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.

Background: Viral superinfection of skin affected by preceding dermatosis has been studied extensively in eczema and reported anecdotally in pemphigus. Little is known about its involvement and complications in patients with other immunobullous diseases.

Methods: To investigate clinical features and complications of viral superinfection in patients with immunobullous diseases, we performed a retrospective chart review. Read More

Chin Med J (Engl) 2015 Oct;128(20):2833-4

Department of Dermatology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.

J Allergy Clin Immunol 2015 Dec 3;136(6):1591-1600. Epub 2015 Sep 3.

Department of Pediatrics, National Jewish Health, 1400 Jackson St, Denver, CO.

Background: A subset of atopic dermatitis is associated with increased susceptibility to eczema herpeticum (ADEH+). We previously reported that common single nucleotide polymorphisms (SNPs) in the IFN-γ (IFNG) and IFN-γ receptor 1 (IFNGR1) genes were associated with the ADEH+ phenotype.

Objective: We sought to interrogate the role of rare variants in interferon pathway genes for the risk of ADEH+. Read More

Pediatr Emerg Care 2015 Aug;31(8):586-8

From the *School of Medicine and †Department of Dermatology, New York Medical College, New York, NY; ‡Dermatology, The University of Texas at Austin Dell Medical School, Austin, TX.

Eczema herpeticum is an easily missed entity most commonly seen in the pediatric population and carries the risk of systemic compromise and a 10% mortality rate. Clinicians should maintain high clinical suspicion when encountering children or young adults with a history of atopic dermatitis or other erosive dermatoses and who present with vesicular lesions, punched-out erosions, and systemic symptoms. We present 3 severe cases of eczema herpeticum that were potentially overlooked and demonstrate the need for elevated awareness to avoid potential pitfalls. Read More

Allergy 2015 Nov 2;70(11):1432-9. Epub 2015 Sep 2.

Department of Dermatology and Allergy, Friedrich-Wilhelms-University, Bonn, Germany.

Background: Atopic dermatitis (AD) is a heterogenous and highly complex disease characterized by an increased microbial colonization. For unknown reasons, a subgroup of patients with AD develops Eczema herpeticum (EH), a severe viral complication due to spreading of herpes simplex virus (HSV). Indoleamine 2,3-dioxygenase (IDO1) is a tryptophan (Trp)-catabolizing enzyme which is assumed to be instrumental in the antibacterial and antiviral defence mechanisms. Read More

Gac Med Mex 2015 Mar-Apr;151(2):252-5

Departamento de Dermatología, Hospital Central «Dr. Ignacio Morones Prieto», Universidad Autónoma de San Luis Potosí, San Luis Potosí, S.L.P., Mexico.

Eczema herpeticum is an acute dermatoses caused by herpes simplex virus type 1 in atopic dermatitis patients, and is considered a dermatology emergency. Eczema herpeticum occurs in less than 3% of atopic patients. We report a patient with a history of atopic dermatitis who presented to an emergency department with eczema herpeticum. Read More

J Dermatol 2015 08 28;42(8):795-9. Epub 2015 Apr 28.

Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.

Varicella is a highly contagious infection caused by varicella zoster virus. Sometimes it is difficult to differentiate between other viral infections such as Kaposi's varicelliform eruption (KVE) and disseminated herpes zoster (HZ). The large unstained cells (LUC) value is a differential count parameter reported by routing hematology analysis. Read More

J Allergy Clin Immunol 2015 Jun 30;135(6):1511-8.e6. Epub 2015 Jan 30.

Division of Immunology, Boston Children's Hospital and the Department of Medicine, Harvard Medical School, Boston, Mass.

Background: Eczema vaccinatum is a life-threatening complication of smallpox vaccination in patients with atopic dermatitis (AD) characterized by dissemination of vaccinia virus (VV) in the skin and internal organs. Mutations in the filaggrin (FLG) gene, the most common genetic risk factor for AD, confer a greater risk for eczema herpeticum in patients with AD, suggesting that it impairs the response to cutaneous viral infections.

Objective: We sought to determine the effects of FLG deficiency on the response of mice to cutaneous VV inoculation. Read More

BMJ Case Rep 2015 Jan 30;2015. Epub 2015 Jan 30.

Department of Ophthalmology, Cwm Taf University Health Board, Llantrisant, UK.

Eczema herpeticum is a rare and potentially life-threatening viral infection. We present the case of a 54-year-old man who presented to the emergency eye clinic with a dendritic ulcer and a facial rash. An initial diagnosis of herpes zoster ophthalmicus was suspected. Read More

J Gen Virol 2015 May 22;96(Pt 5):1067-79. Epub 2015 Jan 22.

Roslin Institute, University of Edinburgh, Easter Bush, Edinburgh EH25 9RG, UK

Human coxsackievirus A6 (CVA6) is an enterically transmitted enterovirus. Until recently, CVA6 infections were considered as being of minor clinical significance, and only rarely aetiologically linked with hand, foot and mouth disease (HFMD) associated with other species A enteroviruses (particularly EV71 and CVA16). From 2008 onwards, however, CVA6 infections have been associated with several outbreaks worldwide of atypical HFMD (aHFMD) accompanied by a varicelliform rash. Read More

J Am Acad Dermatol 2015 Mar 10;72(3):481-4. Epub 2015 Jan 10.

Department of Dermatology, Mayo Clinic, Rochester, Minnesota. Electronic address:

Background: Kaposi varicelliform eruption (KVE), or herpes simplex virus (HSV) superinfection of pre-existing skin lesions, may complicate Darier disease.

Objective: We sought to compare the clinical features and outcomes of patients with Darier disease who developed KVE superinfection with those who did not.

Methods: A 20-year retrospective analysis of 79 patients with Darier disease treated at our institution was performed. Read More

G Ital Dermatol Venereol 2016 Oct 11;151(5):558-61. Epub 2014 Dec 11.

Dermatological Unit, Department of Clinical and Molecular Sciences, Polytehnic Marche University, Ancona, Italy -

Darier-White Disease (DW), otherwise known as keratosis follicularis, is a rare genodermatosis with autosomal dominant inheritance, characterized by loss of adhesion between epidermal cells and abnormal keratinization. The distinctives lesions of DW Disease include rough papules in seborrheic areas, palmoplantar pits, mucosal involvement, and nail changes. DW Disease can be occasionally associated with bacterial complications, but rarely with viral ones. Read More

PLoS One 2014 8;9(12):e114374. Epub 2014 Dec 8.

Department of Immunology and Microbiology, 1st Medical Faculty, Charles University, Studnickova 7, 128 00, Prague 2, Czech Republic.

Smallpox vaccine based on live, replicating vaccinia virus (VACV) is associated with several potentially serious and deadly complications. Consequently, a new generation of vaccine based on non-replicating Modified vaccinia virus Ankara (MVA) has been under clinical development. MVA seems to induce good immune responses in blood tests, but it is impossible to test its efficacy in vivo in human. Read More

Immunol Allergy Clin North Am 2015 Feb 21;35(1):161-83. Epub 2014 Nov 21.

Genetics and Pathophysiology of Allergy Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA. Electronic address:

Atopic dermatitis (AD) is a chronic, relapsing, highly pruritic skin condition resulting from disruption of the epithelial barrier and associated immune dysregulation in the skin of genetically predisposed hosts. AD generally develops in early childhood, has a characteristic age-dependent distribution and is commonly associated with elevated IgE, peripheral eosinophilia, and other allergic diseases. Medications such as antihistamines have demonstrated poor efficacy in controlling AD-associated itch. Read More

Arch Dis Child Educ Pract Ed 2015 Apr 18;100(2):64-8. Epub 2014 Nov 18.

Paediatric Infectious Disease & Immunology department, Bristol Royal Hospital for Children, Bristol, UK.

Eczema herpeticum (EH) occurs when there is secondary skin infection with herpes simplex virus in an atopic patient. The patient may not have unusually severe or active eczema. It is thought that the abnormal skin barrier function predisposes to infection, which can spread rapidly. Read More

Dermatol Pract Concept 2014 Oct 31;4(4):29-31. Epub 2014 Oct 31.

Department of Clinical Medicine, Dermatology Center, Rio Grande do Norte University, Natal, Brazil.

Background: Herpetic eczema is a herpetic superinfection of a preexisting skin disease. Hailey-Hailey disease is an autosomal dominant dermatosis that is clinically characterized by flaccid vesicles and rashes in intertriginous areas. The coexistence of those findings is a rare condition; only five cases have been published in literature. Read More

J Allergy Clin Immunol 2014 Oct 23;134(4):848-55. Epub 2014 Aug 23.

Department of Pediatrics, National Jewish Health, Denver, Colo; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo. Electronic address:

Background: A subset of patients with atopic dermatitis (AD) is prone to disseminated herpes simplex virus (HSV) infection (ie, atopic dermatitis with a history of eczema herpeticum [ADEH+]). Biomarkers that identify ADEH+ are lacking.

Objective: We sought to search for novel ADEH+ gene signatures in PBMCs. Read More

Case Rep Oncol 2014 May 27;7(2):337-42. Epub 2014 May 27.

Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea ; Department of Institute for Cancer Research, Yonsei University College of Medicine, Seoul, Korea ; Department of Brain Korea 21 Project for Medical Science, Seoul, Korea.

Kaposi's varicelliform eruption is a cutaneous eruption caused by the herpes simplex virus and a few other viruses that infect persons with pre-existing dermatosis such as atopic dermatitis. We report the case of a 56-year-old man who was treated with the mammalian target of rapamycin inhibitor, everolimus, for metastatic renal cell carcinoma. He presented with painful, umbilicated vesicles and pustules on his face, genital region, forearms, and legs suggestive of Kaposi's varicelliform eruption. Read More

Br J Dermatol 2014 Jul 9;170 Suppl 1:7-11. Epub 2014 May 9.

Department of Dermatology and Allergy, Ludwig Maximilian University, Frauenlobstr. 9-11, D-80337, Munich, Germany.

Atopic dermatitis (AD) is a common, chronic inflammatory skin disease with a highly variable clinical phenotype and heterogeneous pathophysiology. Its pathogenesis is associated with alterations to both the skin barrier and the immune system, which may in turn be influenced by genetic mutations and the patient's environment. Basic and translational research, as well as clinical trials, have helped broaden our knowledge of the molecular mechanisms underlying the development of AD and to identify potential treatment targets and approaches. Read More

Clin J Sport Med 2015 Jan;25(1):e18-9

*Northeast Ohio Medical University, Rootstown, Ohio; †Case Western Reserve University School of Medicine, Cleveland, Ohio; and ‡Department of Sports Medicine, Summa Health System, Akron, Ohio.

Eczema herpeticum (EH), first described in 1887, is characterized by a disseminated skin infection consisting of dome-shaped papules and is associated with fever, lymphadenopathy, and malaise. The condition commonly occurs on the trunk, head, and neck and is associated with numerous skin conditions, including atopic dermatitis. It is a result of a superimposed herpes simplex virus infection on otherwise compromised skin. Read More

Euro Surveill 2014 Mar 27;19(12):20745. Epub 2014 Mar 27.

Department of Dermatology, Lauriston Building, Edinburgh, United Kingdom.

In January to February 2014, 16 hand, foot and mouth disease (HFMD) cases were identified in Edinburgh, United Kingdom. All presented with atypical features, with most (n=13) resembling eczema herpeticum or chickenpox. Coxsackievirus A6 (CV-A6) was identified in all the typed cases (n=11). Read More

Ann Acad Med Singapore 2014 Feb;43(2):130-1

Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Malaysia.

Clin Immunol 2014 Feb 27;150(2):153-60. Epub 2013 Nov 27.

Department of Pediatrics, Boston Children's Hospital, Boston, MA 02115, USA. Electronic address:

Individuals with atopic dermatitis (AD) are susceptible to a severe, potentially fatal, systemic infection and inflammatory response following exposure to Vaccinia virus (VV). IL-10 acts both as an inducer of Th2 responses and as a regulator of T cell activation. It has been shown to limit skin inflammation elicited by contact sensitizers. Read More

J Immunol 2014 Feb 30;192(3):969-78. Epub 2013 Dec 30.

Division of Flow Cytometry, Kyorin University Graduate School of Medicine, Mitaka, Tokyo 181-8611, Japan.

It remains unknown why the occurrence of eczema herpeticum (EH) caused by an extensive disseminated cutaneous infection with HSV-1 or HSV-2 is associated with the exacerbation of atopic dermatitis lesions after withdrawal of treatment. Although regulatory T cells (Tregs) limit the magnitude of HSV-specific T cell responses in mice, their role in the induction and resolution of EH has not been defined. We initially investigated the frequencies, phenotype, and function of Tregs in the peripheral blood of atopic dermatitis with EH (ADEH) patients at onset and after clinical resolution, atopic dermatitis patients without EH, and healthy controls. Read More