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Review
. 2021 Jan;126(1):3-12.
doi: 10.1016/j.anai.2020.08.002. Epub 2020 Aug 7.

The infectious complications of atopic dermatitis

Vivian Wang  1 , Juri Boguniewicz  2 , Mark Boguniewicz  3 , Peck Y Ong  4
Affiliations
Review

The infectious complications of atopic dermatitis

Vivian Wang et al. Ann Allergy Asthma Immunol. 2021 Jan.

Abstract

Objective: Atopic dermatitis (AD) is a chronic inflammatory skin disease that is complicated by an increased risk for skin and systemic infections. Preventive therapy for AD is based on skin barrier improvement and anti-inflammatory treatments, whereas overt skin and systemic infections require antibiotics or antiviral treatments. This review updates the pathophysiology, diagnosis, management, controversy of antibiotic use, and potential treatments of infectious complications of AD.

Data sources: Published literature obtained through PubMed database searches and clinical pictures.

Study selections: Studies relevant to the mechanisms, diagnosis, management, and potential therapy of infectious complications of AD.

Results: Skin barrier defects, type 2 inflammation, Staphylococcusaureus colonization, and cutaneous dysbiosis are the major predisposing factors for the increased infections in AD. Although overt infections require antibiotics, the use of antibiotics in AD exacerbation remains controversial.

Conclusion: Infectious complications are a comorbidity of AD. Although not common, systemic bacterial infections and eczema herpeticum can be life-threatening. Preventive therapy of infections in AD emphasizes skin barrier improvement and anti-inflammatory therapy. The use of antibiotics in AD exacerbation requires further studies.

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Figures

Figure 1
Figure 1
Dysbiosis and immune dysregulation of atopic dermatitis. IL, interleukin; ILC2, innate lymphoid cells 2; S aureus, Staphylococcus aureus; TH2, T-helper cells type 2; TSLP, thymic stromal lymphopoietin.
Figure 2
Figure 2
Impetigo in a child with atopic dermatitis.
Figure 3
Figure 3
Eczema herpeticum.
Figure 4
Figure 4
Eczema coxsakium with palm lesions.
Figure 5
Figure 5
Molluscum contagiosum along with the flexural areas of a patient with atopic dermatitis.
Figure 6
Figure 6
Principles of infection prevention and treatment in atopic dermatitis. IL, interleukin; S aureus, Staphylococcus aureus; TH17, T-helper 17 cells.
See this image and copyright information in PMC

References

    1. Capozza K., Gadd H., Kelley K., Russell S., Shi V., Schwartz A. Insights from caregivers on the impact of pediatric atopic dermatitis on families: “I’m tired, overwhelmed, and feel like I’m failing as a mother.”. Dermatitis. 2020;31(3):223–227. - PubMed
    1. Ong P.Y., Leung D.Y. Bacterial and viral infections in atopic dermatitis: a comprehensive review. Clin Rev Allergy Immunol. 2016;51(3):329–337. - PubMed
    1. Narla S., Silverberg J.I. Association between atopic dermatitis and serious cutaneous, multiorgan, and systemic infections in US adults. Ann Allergy Asthma Immunol. 2018;120(1):66–72.e11. - PMC - PubMed
    1. Wang V., Keefer M., Ong P.Y. Antibiotic choice and methicillin-resistant Staphylococcus aureus rate in children hospitalized for atopic dermatitis. Ann Allergy Asthma Immunol. 2019;122(3):314–317. - PubMed
    1. Sandhu J.K., Salame N., Ehsani-Chimeh N., Armstrong A.W. Economic burden of cutaneous infections in children and adults with atopic dermatitis. Pediatr Dermatol. 2019;36(3):303–310. - PubMed

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