Cutaneous infections in Atopic Dermatitis (AD) – a literature review

Authors

  • Małgorzata Rodak Department of Internal Medicine, Bonifraters Medical Center, Katowice, Poland Author
  • Ksawery Adamiec Faculty of Medical Sciences, Medical University of Silesia in Katowice, Poland Author
  • Magdalena Kajzar Department of Internal Medicine, Bonifraters Medical Center, Katowice, Poland Author
  • Kamila Nitka Department of Internal Medicine, Łańcut Medical Center, Poland Author
  • Magdalena Iwan Faculty of Medical Sciences, Medical University of Silesia in Katowice, Poland Author
  • Natalia Piątkowska Department of Internal Medicine, Provincial Hospital in Poznań, Poland Author
  • Błażej Szymczuk Faculty of Medical Sciences, Medical University of Silesia in Katowice, Poland Author
  • Joanna Smorońska-Rypel Department of Internal Medicine, Bonifraters Medical Center, Katowice, Poland Author
  • Dominik Trojanowski Faculty of Medical Sciences, Medical University of Silesia in Katowice, Poland Author
  • Jakub Milczarek Faculty of Medical Sciences, Medical University of Silesia in Katowice, Poland Author

DOI:

https://doi.org/10.12923/2083-4829/2024-0007

Keywords:

Staphylococcus aureus, Eczema Herpeticum, HPV, Molluscum Contagiosum

Abstract

Atopic dermatitis (AD) is a chronic inflammatory disease that affects people of all ages, usually with onset in childhood. It is a multifactorial, complex disorder that causes disruption of the skin barrier and is associated with an abnormal immune response that can predispose to both cutaneous and extracutaneous infections with the potential to become systemic infections.

The aim of this article is to present cutaneous infections as the most common complications of atopic dermatitis (AD). Atopic dermatitis (AD) increases susceptibility to skin viral and bacterial infections. These include Staphylococcus aureus colonization, molluscum contagiosum (MC), eczema herpeticum (EH) and human papilloma virus (HPV) infection. Among them, Staphylococcus aureus infection is the most frequently observed. Molluscum contagiosum (MC) and AD are considered risk factors for each other. However, studies on the relationship between MC and AD are divergent and there is a need for further research. Eczema herpeticum and systemic infections can be life-threatening nevertheless they are not common. Individuals with AD are more prone to HPV infections with various subtypes. Research shows that AD increases the risk of cervical cancer. Cutaneous infections are the most common complication of atopic dermatitis (AD) and are associated with various health risks. Preventive therapy in AD emphasizes improving the skin barrier. Early recognition of skin infections and introduction of adequate therapy is important to prevent serious medical complications.

References

1. Chatrath S, Silverberg JI. Phenotypic differences of atopic dermatitis strat¬ified by age. JAAD Int. 2022;11:1-7.

2. Kolb L, Ferrer-Bruker SJ. Atopic Dermatitis. In: StatPearls. Treasure Is¬land (FL): StatPearls Publishing; 2024. [https://www.ncbi.nlm.nih.gov/ books/NBK448071/]

3. Silverberg JI, Vakharia PP, Chopra R, et al. Phenotypical differences of childhood- and adult-onset atopic dermatitis. J Allergy Clin Immunol. 2018;6(4):1306-12.

4. Tanei R. Atopic dermatitis in older adults: A review of treatment options. Drugs Aging. 2020;37(3):149-60.

5. Langan SM, Irvine AD, Weidinger S. Atopic dermatitis. Lancet. 2020;396(10247):345-60.

6. Kolb L, Ferrer-Bruker SJ. Atopic Dermatitis. In: StatPearls. Treasure Is¬land (FL): StatPearls Publishing; 2024. [https://www.ncbi.nlm.nih.gov/ books/NBK448071/]

7. Yaghmaie P, Koudelka CW, Simpson EL. Mental health comorbidity in pa¬tients with atopic dermatitis. J Allergy Clin Immunol. 2013;131(2):428-33.

8. Yu SH, Attarian H, Zee P, et al. Burden of sleep and fatigue in US adults with atopic dermatitis. Dermatitis. 2016;27(2):50-8.

9. Chang YS, Chiang BL. Sleep disorders and atopic dermatitis: A 2-way street? J Allergy Clin Immunol. 2018;142(4):1033-40.

10. Hill DA, Spergel JM. The atopic march: Critical evidence and clinical rel¬evance. Ann Allergy Asthma Immunol. 2018;120(2);131-7.

11. Yang G, Seok JK, Kang HC, et al. Skin barrier abnormalities and immune dysfunction in atopic dermatitis. Int J Mol Sci. 2020;21(8):2867.

12. Silverberg JI. Associations between atopic dermatitis and other disorders. F1000Res. 2018;7:303.

13. Brunner PM, Silverberg JI, Guttman-Yassky E, et al. Increasing comorbid¬ities suggest that atopic dermatitis is a systemic disorder. Int J Dermatol. 2017;137(1):18-25.

14. Narla S, Silverberg JI. Association between atopic dermatitis and serious cutaneous, multiorgan and systemic infections in US adults. Ann Allergy Asthma Immunol. 2018;120(1):66-72.

15. Wollenberg A, Werfel T, Ring J, et al. Atopic dermatitis in children and adults – diagnosis and treatment. Dtsch Arztebl Int. 2023;120(13):224-34.

16. Silverberg JI, Silverberg NB. Childhood atopic dermatitis and warts are associated with increased risk of infection: a US population-based study. J Allergy Clin Immunol. 2014;133(4):1041-7.

17. Wahab MA, Rahman MH, Khondker L, et al. Minor criteria for atopic dermatitis in children. Mymensingh Med J. 2011;20(3):419-24.

18. Wang V, Keefer M, Ong PY. Antibiotic choice and methicillin-resistant Staphylococcus aureus rate in children hospitalized for atopic dermatitis. Ann Allergy Asthma Immunol. 2019;122(3):314-7.

19. Strom MA, Silverberg JI. Association between atopic dermatitis and ex¬tracutaneous infections in US adults. Br J Dermatol. 2017;176(2):495-7.

20. Wang V, Boguniewicz J, Boguniewicz M, et al. The infectious complications of atopic dermatitis. Ann Allergy Asthma Immunol. 2021;126(1):3-12.

21. Fenner J, Silverberg NB. Skin diseases associated with atopic dermatitis. Clin Dermatol. 2018;36(5):631-40.

22. Silverberg NB. Molluscum contagiosum virus infection can trigger atopic dermatitis disease onset or flare. Cutis. 2018;102(3):191-4.

23. Wan J, Shin DB, Syed MN, et al. Risk of herpesvirus, serious and oppor¬tunistic infections in atopic dermatitis: a population-based cohort study. Br J Dermatol. 2022;186(4):664-72.

24. Del Giudice P. Skin infections caused by Staphylococcus aureus. Acta Derm Venereol. 2020;100(9):110.

25. George SM, Karanovic S, Harrison DA, et al. Interventions to reduce Staphylococcus aureus in the management of eczema. Cochrane Database Syst Rev. 2019;2019(10):CD003871.

26. Kim J, Kim BE, Ahn K, et al. Interactions between atopic dermatitis and staphylococcus aureus infection: Clinical implications. Allergy Asthma Immunol Res. 2019;11(5):593-603.

27. Kim BE, Leung DYM. Significance of skin barrier dysfunction in atopic dermatitis. Allergy Asthma Immunol Res. 2018;10(3):207-15.

28. Ogonowska P, Szymczak K, Empel J, et al. Staphylococcus aureus from Atopic Dermatitis Patients: Its genetic structure and susceptibility to pho¬totreatment. Microbiol Spectr. 2021;11(3):e0459822.

29. Hon KL, Tsang YC, Pong NH, et al. Clinical features and Staphylococcus aureus colonization/infection in childhood atopic dermatitis. J Dermatol Treat. 2016;27(3):235-40.

30. Kim J, Kim BE, Ahn K, et al. Interactions Between atopic dermatitis and staphylococcus aureus infection: Clinical implications. Allergy Asthma Immunol Res. 2019;11(5):593-603.

31. Leung AKC, Barankin B, Hon KLE. Molluscum contagiosum: An update. Recent Patents Infla. 2017;11(1):22-31.

32. Hebert AA, Bhatia N, Del Rosso JQ. Molluscum contagiosum: epidemiol¬ogy, considerations, treatment options, and therapeutic gaps. J Clin Aesthet Dermatol. 2023;16(8 Suppl 1):S4-S11.

33. Shisler JL. Immune evasion strategies of molluscum contagiosum virus. Adv Virus Res. 2015;92:201-52.

34. Olsen JR, Gallacher J, Finlay AY, et al. Time to resolution and effect on quality of life of molluscum contagiosum in children in the UK: a prospec¬tive community cohort study. Lancet Infect Dis. 2015;15(2):190-5.

35. Olsen JR, Piguet V, Gallacher J, et al. Molluscum contagiosum and asso¬ciations with atopic eczema in children: a retrospective longitudinal study in primary care. Br J Gen Pract. 2016;66(642):53-8.

36. Andre N, Alyagon A, Jurban E, et al. Does molluscum contagiosum need to be managed differently in atopic children? Acta Derm Venereol. 2024;104:39983.

37. Meza-Romero R, Navarrete-Dechent C, Downey C. Molluscum contagio¬sum: an update and review of new perspectives in etiology, diagnosis, and treatment. Clin Cosmet Investig Dermatol. 2019;12:373-81.

38. Ring J, Alomar A, Bieber T, et al. Guidelines for treatment of atopic eczema (atopic dermatitis) part I. J Eur Acad Dermatol Venereol. 2021;26(8):1045-60.

39. Xiao A, Tsuchiya A. Eczema Herpeticum. [Updated 2023 Aug 8]. In: Stat-Pearls. Treasure Island (FL): StatPearls Publishing; 2024. [https://www. ncbi.nlm.nih.gov/books/NBK560781/]

40. Wollenberg A, Wetzel S, Burgdorf WH, et al. Viral infections in atopic dermatitis: pathogenic aspects and clinical management. J Allergy Clin Immunol. 2003;112(4):667-74.

41. Zhuang K, Wu Q, Ran X, et al. Oral treatment with valacyclovir for HSV-2-associated eczema herpeticum in a 9-month-old infant: A case report. J Med. 2016;95(29):4284.

42. Leung DY. Why is eczema herpeticum unexpectedly rare? Antiviral Res. 2013;98(2):153-7.

43. Ong PY, Leung DY. Bacterial and viral infections in atopic dermatitis: a comprehensive review. Clin Rev Allergy Immunol. 2016;51(3):329-37.

44. Currie J, Wright R, Miller O. The frequency of warts in atopic patients. Cutis. 1971;8:243-5

45. Stefanaki C, Stefanaki I, Verra P, et al. Atopic patients with genital warts have a more protracted clinical course and a greater probability of recur¬rences. Int J STD AIDS. 2010;21(10):723-7.

46. Morgan TK, Hanifin J, Mahmood M, et al. Atopic Dermatitis is associated with cervical high risk human papillomavirus infection. J Low Genit Tract Dis. 2015;19(4):345-9.

47. 47Jones AL, Curran-Everett D, Leung DYM. Food allergy is associated with Staphylococcus aureus colonization in children with atopic dermatitis. J Allergy Clin Immunol. 2016;137(4):1247-8.

48. Stevens DL, Bryant AE. Streptococcus pyogenes impetigo, erysipelas, and cellulitis. 2022 Sep 7 [Updated 2022 Oct 4]. In: Ferretti JJ, Stevens DL, Fischetti VA (ed). Streptococcus pyogenes: Basic biology to clinical manifestations. 2nd edition. Oklahoma City (OK): University of Oklaho¬ma Health Sciences Center; 2022. [https://www.ncbi.nlm.nih.gov/books/ NBK587091/]

49. Shayegan LH, Richards LE, Morel KD, et al. Punched-out erosions with scalloped borders: Group A Streptococcal pustulosis. Pediatr Dermatol. 2019;36(6):995-6.

50. Luria L, Cardoza-Favarato G. Human Papillomavirus. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024. [https://www.ncbi.nlm. nih.gov/books/NBK448132/].

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Published

2024-12-31