Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Br J Dermatol. 2022 Apr;186(4):664-672. doi: 10.1111/bjd.20887. Epub 2022 Jan 20.
Staphylococcal and herpes simplex virus (HSV) infections are commonly recognized in atopic dermatitis (AD), but less is known about other types of infections.
To determine the risk of herpesvirus infections, serious infections and opportunistic infections in patients with AD.
We conducted a population-based cohort study using UK-based electronic medical records data. Patients with AD were each matched to up to five unaffected patients on age, practice and index date. AD severity was defined using treatments as a proxy. Outcomes were incident herpesvirus infections [cytomegalovirus (CMV), Epstein-Barr virus (EBV), HSV or varicella zoster virus (VZV)], serious infections and opportunistic infections.
Among 409 431 children and 625 083 adults with AD matched to 1 809 029 children and 2 678 888 adults without AD, respectively, adjusted Cox regression models showed children and adults with AD had a 50-52% greater risk of HSV and 18-33% greater risk of VZV, with risk increasing in parallel with AD severity. CMV risk was elevated among children with AD [hazard ratio (HR) 2·50, 95% confidence interval (95% CI) 1·38-4·54] and adults with severe AD (HR 4·45, 95% CI 1·76-11·25). Patients with AD had a 26-40% increase in risk of serious infections, with severe AD carrying the greatest risk. Although rare, opportunistic infections were associated with all severities of AD in adults (overall HR 1·31, 95% CI 1·20-1·42), but were not associated with AD in children. All estimates remained consistent after excluding patients receiving immunosuppressive treatments for AD.
AD is significantly associated with herpesvirus infections, serious infections and opportunistic infections in a 'dose-dependent' manner with increasing severity. AD may increase susceptibility to infections exclusive of immunosuppressive medications.
金黄色葡萄球菌和单纯疱疹病毒（HSV）感染在特应性皮炎（AD）中较为常见，但对其他类型的感染了解较少。
确定 AD 患者发生疱疹病毒感染、严重感染和机会性感染的风险。
我们使用英国电子病历数据开展了一项基于人群的队列研究。AD 患者按照年龄、就诊机构和索引日期，与至多 5 名无 AD 的患者进行匹配。使用治疗药物作为替代指标，定义 AD 严重程度。结局为新发疱疹病毒感染（巨细胞病毒（CMV）、EB 病毒（EBV）、HSV 或水痘-带状疱疹病毒（VZV））、严重感染和机会性感染。
在分别匹配至 409431 名儿童和 625083 名成人的 1809029 名儿童和 2678888 名成人无 AD 患者中，经调整的 Cox 回归模型显示，AD 儿童和成人发生 HSV 的风险增加 50%-52%，发生 VZV 的风险增加 18%-33%，且风险随 AD 严重程度平行增加。AD 儿童的 CMV 风险升高[风险比（HR）2.50，95%置信区间（95%CI）1.38-4.54]，严重 AD 成人的 CMV 风险升高[HR 4.45，95%CI 1.76-11.25]。AD 患者发生严重感染的风险增加 26%-40%，严重 AD 患者的风险最大。虽然机会性感染罕见，但在所有严重程度的 AD 成人中均与 AD 相关（总体 HR 1.31，95%CI 1.20-1.42），但在儿童中与 AD 无关。在排除接受 AD 免疫抑制治疗的患者后，所有估计值仍然一致。
AD 与疱疹病毒感染、严重感染和机会性感染显著相关，且严重程度呈“剂量依赖性”增加。AD 可能增加对感染的易感性，而与免疫抑制药物无关。
