Herpetic eczema in children with atopic dermatitis: Prognosis, clinical and immunological diagnostics and management tactics

Herpetic eczema (HE), being a manifestation of disseminated herpetic infection, mainly complicates the course of atopic dermatitis (AtD). This is a potentially life-threatening infection for children, the mortality of which, according to the literature, reaches 9%. Early diagnosis of HE helps to reduce the incidence of adverse outcomes and improve treatment quality for these patients. The goal is to improve the management tactics of children with herpetic eczema based on the patient-oriented algorithm for monitoring children with AtD risk groups, taking into account the predictors complex of disease development and severity. Material and methods: the single-center prospective observational study included 150 children aged from 4 months to 18 years with AtD. The main group consisted of 113 children with HE caused by AtD, the comparison group – 37 children with AtD in the exacerbation period not combined with HE. HSV infection is confirmed by determining the virus DNA in blood by the method of polymerase chain reaction. The diagnosis of AtD in children was verified according to the criteria proposed by J. Hanifin and G. Rajka. The severity of AtD at the time of inspection was assessed according to the SCORAD scale. Results: the main predictors of HE development in patients with AtD are: age up to 1 year (increase in relative risk (IRR) 2,86, 95% confidence interval (CI) 7,91/0,68, p<0,001), autumn-winter period (IRR 1,68, 95% CI 5,3/0,15, p=0,018), close relatives with combination of pollinosis and asthma (IRR 2,56, 95% CI – 9,95/–0,16, p<0,001), moderate or severe form of AtD (IRR 0,91, 95% CI – 2,11/–0,17, p<0,001). Laboratory immunological signs of HE developing risk in children with AtD include eosinophilia more than 3•109/l (p<0,001); an increased level of IL8 more than 2 times the norm value (p<0,001); prediction of a severe course of the disease — an increase in total IgE level to 850 kE/l (p<0,017) and an increase TNFα serum concentration above 2 pg/ml (p<0,001). Conclusion: the combination of at least 3 risk factors allows to classify a patient with AtD as a high risk group for HE development with recommendations for nonspecific prophylaxis, namely: separation from patients with manifest HSV infection. If a child has a high risk of HE adverse course, differentiated therapy is necessary, сonsidering the possible accession of a secondary infection and the exacerbation of AtD after HE regression. © 2019, Pediatria Ltd.. All rights reserved.