Reviews and Feature Articles
Viral infections in atopic dermatitis: Pathogenic aspects and clinical management

https://doi.org/10.1016/j.jaci.2003.07.001Get rights and content

Abstract

A number of different widespread and disseminated viral infections can occur in patients with atopic dermatitis. Eczema molluscatum is troublesome but not dangerous. Although eczema vaccinatum is rare, it is life-threatening and of increased concern as smallpox vaccinations are reintroduced as a response to possible bioterrorism. There is little information on the course of smallpox itself in atopic dermatitis. Eczema herpeticum is the most common member of this group; recent advances in understanding its pathogenesis might contribute to a more successful management of this serious complication.

Section snippets

Molluscum contagiosum: EM

Molluscum contagiosum virus (MCV) is a poxvirus and the sole member of the Molluscipoxvirus subfamily. It is highly distinct from variola, vaccinia, and cowpox viruses, which belong to the Orthopoxvirinae genus. Virus particles are brick shaped with round corners and contain a large, double-stranded DNA genome of 130 to 300 kb. The key feature of the diverse poxviruses is replication in the cytoplasm mediated by distinct enzymes not present in other DNA viruses. The poxviruses are brick shaped

Orthopoxvirus infection: EV

Variola virus, which causes smallpox; vaccinia virus, which is used for vaccination; and cowpox virus all belong to the Orthopoxvirinae genus and share many clinical similarities.

Outlook

The number of immunocompromised individuals has clearly increased in the past 3 decades because of HIV/AIDS, more extensive use of immunosuppressive therapy, and an apparent increase in AD.65 Consequently, the number of patients with EH, EV, and EM is likely to increase. Unfortunately, only a few studies with larger numbers of patients give hints on epidemiologic data.

At present, EH is the clinically most important disseminated cutaneous viral infection in patients with AD. EM is less

Acknowledgements

We thank Prof. Dr. Dr. h.c. Gerd Plewig, FRCP, for critical reading of the manuscript.

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