History of S. aureus Skin Infection Significantly Associates with History of Eczema Herpeticum in Patients with Atopic Dermatitis

Abstract

Introduction: Patients with atopic dermatitis (AD) are uniquely susceptible to a number of serious viral skin complications, including eczema herpeticum (EH), caused by herpes simplex virus. This study explored the associations between biomarkers of epithelial barrier dysfunction, type 2 immunity, Staphylococcus aureus infection, and S. aureus-specific immunoglobulin responses in a cohort of AD subjects with and without a history of EH (EH+ and EH-, respectively).

Methods: A total of 112 subjects with AD (56 EH+, 56 EH-), matched by age and AD severity, were selected from a registry of over 3000 AD subjects. Logistic regression was used to test the association between history of S. aureus skin infection and history of EH, while controlling for a number of confounders.

Results: Compared to those without a history of S. aureus skin infection, subjects with a history of S. aureus skin infection were found to have more than sixfold increased odds of having a history of EH (6.60, 95% confidence interval [CI]: 2.00-21.83), after adjusting for history of other viral skin infections (molluscum contagiosum virus, human papillomavirus), serum total IgE, and IgG against the S. aureus virulence factor SElX.

Conclusions: These findings indicate an important relationship between S. aureus skin infections and EH.

Keywords: Atopic dermatitis; Eczema herpeticum; Immunoglobulins; S. aureus; Viral skin infections.

Fig. 1

Flow chart of study design, matching criteria, and metrics. EASI Eczema Area and Severity Index, EH eczema herpeticum, Ig immunoglobulin, LDH lactate dehydrogenase. Figure created using BioRender (https://www.biorender.com/)

Fig. 2

Schematic of Staphylococcus aureus antigen classes included in the StaphAIR assay. Amd Autolysin domain amidase, CHIPs chemotaxis inhibitory protein of Staphylococcus, ClfA staphylococcal clumping factor A, Gmd autolysin domain glucosaminidase, Hla alpha-hemolysin, Isd iron-regulated surface determinant protein, PVL Panton-Valentine leukocidin, SCIN staphylococcal complement inhibitory protein, TSST-1 toxic shock syndrome toxin-1 Figure created using BioRender (https://www.biorender.com/)