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

Affiliations

¹ Department of Dermatology, University of Rochester Medical Center, Rochester, NY, USA.
² Division of Allergy-Immunology, Department of Pediatrics, Boston Children's Hospital-Harvard Medical School, Boston, MA, USA.
³ Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles-University of Southern California, Los Angeles, CA, USA.
⁴ Department of Dermatology, Oregon Health and Science University, Portland, OR, USA.
⁵ Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health-University of Colorado School of Medicine, Denver, CO, USA.
⁶ Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
⁷ Department of Dermatology, University of Rochester Medical Center, Rochester, NY, USA. lisa_beck@urmc.rochester.edu.

PMID: 37615834
PMCID: PMC10539263
DOI: 10.1007/s13555-023-00996-y

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

Mary C Moran et al. Dermatol Ther (Heidelb). 2023 Oct.

. 2023 Oct;13(10):2417-2429.

doi: 10.1007/s13555-023-00996-y. Epub 2023 Aug 24.

Authors

Affiliations

¹ Department of Dermatology, University of Rochester Medical Center, Rochester, NY, USA.
² Division of Allergy-Immunology, Department of Pediatrics, Boston Children's Hospital-Harvard Medical School, Boston, MA, USA.
³ Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles-University of Southern California, Los Angeles, CA, USA.
⁴ Department of Dermatology, Oregon Health and Science University, Portland, OR, USA.
⁵ Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health-University of Colorado School of Medicine, Denver, CO, USA.
⁶ Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
⁷ Department of Dermatology, University of Rochester Medical Center, Rochester, NY, USA. lisa_beck@urmc.rochester.edu.

PMID: 37615834
PMCID: PMC10539263
DOI: 10.1007/s13555-023-00996-y

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.

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Conflict of interest statement

ADB: Consultant for Abbvie, Incyte Corporation, Sanofi-Advent, dMed Biopharmaceutical Co, Ltd; grant or clinical trial support (grants paid to the institution) from Incyte Crp, Dermira, Kiniksa, Novartis, and Pfizer. LCS: Consultant for Sanofi Genzyme, Abbvie, Leo Pharma; Investigator for Regeneron, DBV Technologies, DSMB-Alladapt Immunotherapeutics, DAIT/NIAID. PYO: Consultant for Incyte, Abbvie, Janssen; Investigator for Regeneron, Sanofi Genzyme, Leo, Incyte. ELS: Personal fees from Advances in Cosmetic Medical Derm Hawaii LLC, AbbVie, Amgen, AOBiome LLC, Arcutis Biotherapeutics, Arena Pharmaceuticals, Aslan Pharma, Boehringer Ingelheim USA, Inc., Boston Consulting Group, Bristol Myers Squibb–BMS, Collective Acumen LLC (CA), CorEvitas, Dermira, Eli Lilly, Evelo Biosciences, Evidera, ExcerptaMedica, FIDE, Forte Bio RX, Galderma, GlaxoSmithKline, Incyte, Janssen, Johnson & Johnson, Kyowa Kirin Pharmaceutical Development, Leo Pharm, Medscape LLC, Merck, MauiDerm, MLG Operating, MJH holding, Pfizer, Physicians World LLC, PRImE, Regeneron, Revolutionizing Atopic Dermatitis Inc, Roivant, Sanofi-Genzyme, Trevi therapeutics, Valeant, Vindico Medical education, WebMD. DYML: Consultant for Aslan Pharma, Genentech, LEO Pharma, and Incyte; Research grants from Sanofi Genzyme. BLM: Named inventor on patents and patent applications related to the Arrayed Imaging Reflectometry (AIR) technology. LAB: Consultant for Allakos, Arena Pharmaceuticals, DermTech, Evelo Biosciences, Galderma, Incyte, Janssen, LEO Pharma, Merck, Numab Therapeutics, Pfizer, Rapt Therapeutics, Regeneron, Ribon Therapeutics, Sanofi/Genzyme, Sanofi-Aventis, Stealth BioTherapeutics, Trevi Therapeutics, Union Therapeutics, and Xencor. DMC member: Novartis; Investigator for Abbvie, Astra-Zeneca, DermTech, Kiniksa, Pfizer, Regeneron, Ribon Therapeutics and Sanofi. MCM, AK, TY and CLS have no conflicting interests to disclose.

Figures

**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/)

See this image and copyright information in PMC

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources