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Clinical Reviews in Allergy & Immunology

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01-08-2020 | Herpes Virus

Eczema Herpeticum: Clinical and Pathophysiological Aspects

Authors: Alexia Damour, Magali Garcia, Julien Seneschal, Nicolas Lévêque, Charles Bodet

Published in: Clinical Reviews in Allergy & Immunology | Issue 1/2020

Abstract

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease in the world. AD is a complex pathology mainly characterized by an impaired skin barrier, immune response dysfunction, and unbalanced skin microbiota. Moreover, AD patients exhibit an increased risk of developing bacterial and viral infections. One of the most current, and potentially life-threatening, viral infection is caused by herpes simplex virus (HSV), which occurs in about 3% of AD patients under the name of eczema herpeticum (EH). Following a first part dedicated to the clinical features, virological diagnosis, and current treatments of EH, this review will focus on the description of the pathophysiology and, more particularly, the presently known predisposing factors to herpetic complications in AD patients. These factors include those related to impairment of the skin barrier such as deficit in filaggrin and anomalies in tight and adherens junctions. In addition, low production of the antimicrobial peptides cathelicidin LL-37 and human β-defensins; overexpression of cytokines such as interleukin (IL)-4, IL-13, IL-25, IL-33, and thymic stromal lymphopoietin (TSLP); or downregulation of type I to III interferons as well as defect in functions of immune cells such as dendritic, natural killer, and regulatory T cells have been involved. Otherwise, genetic polymorphisms and AD topical calcineurin inhibitor treatments have been associated with an increased risk of EH. Finally, dysbiosis of skin microbiota characterized in AD patients by Staphylococcus aureus colonization and toxin secretion, such as α-toxin, has been described as promoting HSV replication and could therefore contribute to EH.

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Title: Eczema Herpeticum: Clinical and Pathophysiological Aspects
Authors: Alexia Damour
Magali Garcia
Julien Seneschal
Nicolas Lévêque
Charles Bodet
Publication date: 01-08-2020
Publisher: Springer US
Keywords: Herpes Virus
Atopic Dermatitis
Respiratory Microbiota
Interferon
Published in: Clinical Reviews in Allergy & Immunology / Issue 1/2020
Print ISSN: 1080-0549
Electronic ISSN: 1559-0267
DOI: https://doi.org/10.1007/s12016-019-08768-3

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