Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany.
Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, Germany.
Allergy. 2021 Oct;76(10):3017-3027. doi: 10.1111/all.14853. Epub 2021 May 3.
Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases leading to pruritic skin lesions. A subset of AD patients exhibits a disseminated severe HSV infection called eczema herpeticum (EH) that can cause life-threatening complications. This review gives an overview of the clinical picture, and characteristics of the patients as well as the diagnosis and therapy of EH. A special focus lies on the pathophysiological hallmarks identified so far that predispose for EH. This aspect covers genetic aberrations, immunological changes, and environmental influences displaying a complex multifactorial situation, which is not completely understood. Type 2 skewing of virus-specific T cells in ADEH patients has been implicated in immune profile abnormalities, along with impaired functions of dendritic cells and natural killer cells. Furthermore, aberrations in interferon pathway-related genes such as IFNG and IFNGR1 have been identified to increase the risk of EH. IL-4, IL-25, and thymic stromal lymphopoietin (TSLP) are overexpressed in EH, whereas antimicrobial peptides like human β-defensins and LL-37 are reduced. Concerning the epidermal barrier, single nucleotide polymorphisms (SNPs) in skin barrier proteins such as filaggrin were identified in ADEH patients. A dysbalance of the skin microbiome also contributes to EH due to an increase of Staphylococcus aureus, which provides a supporting role to the viral infection via secreted toxins such as α-toxin. The risk of EH is reduced in AD patients treated with dupilumab. Further research is needed to identify and specifically target risk factors for EH in AD patients.
特应性皮炎（AD）是最常见的慢性炎症性皮肤病之一，可导致瘙痒性皮肤损伤。一部分 AD 患者会出现广泛的严重单纯疱疹病毒（HSV）感染，称为疱疹样湿疹（EH），可导致危及生命的并发症。本文综述了 EH 的临床特征、患者特征、诊断和治疗。特别关注的是迄今为止确定的易患 EH 的病理生理特征。这方面包括遗传异常、免疫变化和环境影响，表现出复杂的多因素情况，目前尚未完全了解。ADEH 患者的病毒特异性 T 细胞 2 型偏倚被认为与免疫谱异常有关，同时树突状细胞和自然杀伤细胞的功能受损。此外，干扰素途径相关基因（如 IFNG 和 IFNGR1）的异常也被认为会增加 EH 的风险。EH 中过度表达了白细胞介素 4（IL-4）、白细胞介素 25（IL-25）和胸腺基质淋巴细胞生成素（TSLP），而抗菌肽如人β-防御素和 LL-37 则减少。在表皮屏障方面，ADEH 患者的皮肤屏障蛋白（如丝聚合蛋白）中发现了单核苷酸多态性（SNP）。皮肤微生物组的失衡也会导致 EH，因为金黄色葡萄球菌的增加为病毒感染提供了支持作用，其通过分泌的α-毒素等毒素发挥作用。AD 患者接受度普利尤单抗治疗可降低 EH 的风险。需要进一步研究以确定 AD 患者 EH 的风险因素，并针对这些因素进行特异性靶向治疗。
