Atopic dermatitis is a common chronic, relapsing skin disorder, and many patients with atopic dermatitis use complementary and alternative medicine instead of consulting a certified dermatologist. Herein, we report the case of a 38-year-old woman with severe eczema herpeticum who had been treated with herbal medicine and acupuncture for her atopic dermatitis. Herbal medicine and acupuncture are the most frequent types of alternative medicine that Korean patients rely on. However, the effectiveness of these treatments in atopic dermatitis remains unclear as there is a great lack of scientific evidence supporting it. As atopic dermatitis can cause potentially fatal secondary infections such as eczema herpeticum, dermatologists should put great effort into communicating with and educating the patients and in guiding them to choose the most appropriate treatment plan for managing their atopic dermatitis.
Acupuncture ; Adult ; Coinfection ; Complementary Therapies ; Dermatitis, Atopic ; Eczema ; Female ; Herbal Medicine ; Humans ; Kaposi Varicelliform Eruption ; Skin

BACKGROUND: Mutation in the gene encoding filaggrin (FLG) is a major predisposing factor for atopic dermatitis (AD), in association with distinct features such as increased allergic sensitization, higher severity, and frequent skin infections. Genetic diversity in FLG mutations exists across ethnicities. OBJECTIVE: This study aimed to investigate the clinical features of AD according to the presence of FLG mutation in Korean individuals. METHODS: We performed reverse blot hybridization assay to detect FLG mutation in Korean patients with AD. Classifying subjects into AD with or without FLG mutation, clinical features of AD and patch test results were compared between the two groups. RESULTS: Among a total of 281 subjects, 39 (13.9%) were found to have FLG mutation. AD with FLG mutation was associated with higher risk of impetigo and eczema herpeticum but lower risk of prurigo nodularis. In the patch test, there was no difference in positive reactions of major contact allergens between the groups. CONCLUSION: In Korean patients with AD, FLG mutation was associated with more frequent skin infections but not with personal or family history of atopic diseases, allergic sensitization, contact allergy, and protracted course. It is important to consider other skin-barrier-related genes, such as KLK7 and SPINK5, and immune response-related genes in conjunction.
Allergens ; Causality ; Dermatitis, Atopic ; Genetic Variation ; Humans ; Hypersensitivity ; Impetigo ; Kaposi Varicelliform Eruption ; Patch Tests ; Prurigo ; Skin

BACKGROUND: Kaposi varicelliform eruption (KVE) is a disseminated viral infection primarily caused by the herpes simplex virus in the setting of an underlying chronic skin disease. Few studies have reported the clinical characteristics and predisposing factors for recurrent KVE.OBJECTIVES: To characterize the clinical features and predisposing factors for recurrent KVE.METHODS: This retrospective comparative study of recurrent vs. single-episode KVE was performed at the Pusan National University Hospital between 2004 and 2017.RESULTS: A total of 84 episodes occurred in 60 patients, and of these, 13 patients developed recurrence (21.7%). No statistically significant intergroup difference was observed in the mean age and sex distribution. The face was the most common site of involvement in both groups, followed by the trunk and the upper and lower extremities. Atopic dermatitis was the most common pre-existing disease in both groups; however, Darier's disease was more common in the recurrent KVE group, and this difference was statistically significant. Most patients with KVE (66.7%) showed aggravation of the underlying skin disease within 3 months of KVE onset. This finding was more prominent in patients with recurrent episodes (91.7%) than in those with single-episode KVE (58.3%), (p=0.040).CONCLUSION: This study can contribute to a better understanding of recurrent KVE and guide clinicians in treating patients with conditions predisposing to KVE.
Busan ; Causality ; Darier Disease ; Dermatitis, Atopic ; Humans ; Kaposi Varicelliform Eruption ; Lower Extremity ; Preexisting Condition Coverage ; Recurrence ; Retrospective Studies ; Sex Distribution ; Simplexvirus ; Skin Diseases

PURPOSE: This study evaluated the clinical characteristics and risk factors associated with atopic dermatitis patients complicated by eczema herpeticum. METHODS: This study included 45 patients under the age of 18 with atopic dermatitis complicated by eczema herpeticum in the disease group (ADEH+), and 50 patients under the age of 18 with atopic dermatitis without any episode of eczema herpeticum in the control group (ADEH−). We retrospectively reviewed the clinical features, treatment and prognosis of the 2 groups. RESULTS: In this study, eczema herpeticum occurred in 2.7% of the AD patients. No significant difference in percentage of boys or mean age was found between the ADEH+ and ADEH− groups. In the ADEH+ group, eczema herpeticum occurred more frequently in the head and neck. Severe atopic dermatitis, recurrent impetigo, IgE−mediated atopic dermatitis and food allergy were identified as the risk factors of eczema herpeticum. The mean white blood cell count, erythrocyte sedimentation rate, percent of eosinophils and total serum IgE were higher in the ADEH+ group than in the ADEH− group. More than 2 recurrences were confirmed in 12 patients (26.7%). CONCLUSION: In the ADEH+ group, skin lesions were dominant on the head and neck. We revealed that severe atopic dermatitis, frequent impetigo, IgE-mediated atopic dermatitis, and food allergy are risk factors for eczema herpeticum.
Blood Sedimentation ; Child ; Dermatitis, Atopic* ; Eczema* ; Eosinophils ; Food Hypersensitivity ; Head ; Humans ; Immunoglobulin E ; Impetigo ; Kaposi Varicelliform Eruption* ; Leukocyte Count ; Neck ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors ; Simplexvirus ; Skin

PURPOSE: The purpose of this study was to identify the causes, symptoms, and complications of hypoproteinemia to prevent hypoproteinemia and provide appropriate treatment to children with atopic dermatitis. METHODS: Children diagnosed with atopic dermatitis with hypoproteinemia and/or hypoalbuminemia were retrospectively reviewed. The patients’ medical records, including family history, weight, symptoms, treatment, complications, and laboratory test results for allergies and skin cultures, were examined. RESULTS: Twenty-six patients (24 boys) were enrolled. Seven cases had growth retardation; 7, keratoconjunctivitis; 6, aural discharges; 5, eczema herpeticum; 4, gastrointestinal tract symptoms; and 2, developmental delays. In 21 cases, topical steroids were not used. According to the blood test results, the median values of each parameter were elevated: total IgE, 1,864 U/mL; egg white-specific IgE, 76.5 kU(A)/L; milk IgE, 20.5 kU(A)/L; peanut IgE, 30 kU(A)/L; eosinophil count, 5,810/μL; eosinophil cationic protein, 93.45 μg/L; and platelet count, 666.5×10³/μL. Serum albumin and total protein levels decreased to 2.7 g/dL and 4.25 g/dL, respectively. Regarding electrolyte abnormality, 10 patients had hyponatremia, and 12, hyperkalemia. Systemic antibiotics were used to treat all cases, and an antiviral agent was used in 12 patients. Electrolyte correction was performed in 8 patients. CONCLUSION: Hypoproteinemia accompanying atopic dermatitis is common in infants younger than 1 year and may occur because of topical steroid treatment continuously being declined or because of eczema herpeticum. It may be accompanied by growth retardation, keratoconjunctivitis, aural discharge, and eczema herpeticum and can be managed through skin care and topical steroid application without intravenous albumin infusion.
Anti-Bacterial Agents ; Arachis ; Child ; Dermatitis, Atopic* ; Eosinophil Cationic Protein ; Eosinophils ; Gastrointestinal Tract ; Hematologic Tests ; Humans ; Hyperkalemia ; Hypersensitivity ; Hypoalbuminemia ; Hyponatremia ; Hypoproteinemia* ; Immunoglobulin E ; Infant ; Kaposi Varicelliform Eruption ; Keratoconjunctivitis ; Medical Records ; Milk ; Ovum ; Platelet Count ; Retrospective Studies ; Serum Albumin ; Skin ; Skin Care ; Steroids

No abstract available.
Chickenpox* ; Dermatitis, Atopic* ; Herpesvirus 3, Human* ; Humans ; Kaposi Varicelliform Eruption*

PURPOSE: To report a case of endothelial keratitis occurred after reactivation of herpes simplex virus following immunosuppressant therapy for Kaposi's varicelliform eruption. CASE SUMMARY: A 23-year-old female was referred for ocular pain and blurred vision. She had atopic dermatitis and was diagnosed with Kaposi's varicelliform eruption on her face after using an immunosuppressant. Slit lamp examination revealed central corneal edema in the right eye. She was initially diagnosed with contact lens-induced keratitis. Subsequently, the contact lens was removed and topical antiviral agent used for prevention of ocular involvement. Four days after treatment, Wesseley immune ring of deep stromal haze and cells in the anterior chamber were present. She was diagnosed with endothelial keratitis caused by reactivation of herpes simplex virus after using an immunosuppressant. Topical steroid, hypertonic saline eye drops and cycloplegic eye drops were added to the treatment for the progression of endothelial keratitis. Corneal edema was decreased 2 weeks after treatment and anterior chamber cells decreased 1 month after treatment. There was no recurrence during the follow-up period. CONCLUSIONS: Patients diagnosed with Kaposi's varicelliform eruption after using immunosuppressants should have an ophthalmic examination to confirm ocular involvement; use of appropriate eye drops is necessary for the treatment of corneal involvement.
Anterior Chamber ; Corneal Edema ; Dermatitis, Atopic ; Female ; Follow-Up Studies ; Humans ; Immunosuppressive Agents ; Kaposi Varicelliform Eruption* ; Keratitis* ; Ophthalmic Solutions ; Recurrence ; Simplexvirus ; Slit Lamp ; Young Adult

BACKGROUND: Pediatric infectious skin diseases are different from their counterparts in adults, since the sources of infection and disease progressions are distinct. To our knowledge, there have been no reports of epidemiologic studies of pediatric infectious skin diseases in Korea. OBJECTIVE: The purpose of this study was to evaluate the distribution of pediatric infectious skin diseases in the Ansan and Southwestern area of Gyeonggi-do, and to compare the results with previous reports about general pediatric dermatoses. METHODS: The authors retrospectively evaluated 4,366 cases of pediatric infectious skin diseases from July 2003 to June 2013 in the Department of Dermatology at Korea University Ansan Hospital. The monthly, seasonal, and annual incidences, as well as the ages and genders of the patients were evaluated. RESULTS: The study included 2004 (45.0%) girls and 2362 (55.0%) boys. The most frequent age of infection was 4 to 6 years old (range 0~15 years), and the peak incidences occurred in July, August, and January. The most common infectious dermatoses were viral (76.0%), bacterial (11.5%), fungal (8.3%), and parasitic (4.0%). The 10 most common pediatric infectious skin diseases were viral wart (45.8%), molluscum contagiosum (20.9%), impetigo (10.3%), tinea (7.1%), scabies (3.8%), herpes zoster (2.5%), varicella (1.6%), herpes simplex (1.5%), eczema herpeticum (1.1%), and cellulitis (0.9%). CONCLUSION: Compared to previously published reports, the distribution of pediatric infectious skin diseases has changed and was different from general pediatric dermatoses.
Adult ; Cellulitis ; Chickenpox ; Dermatology ; Disease Progression ; Epidemiologic Studies* ; Epidemiology ; Female ; Gyeonggi-do* ; Herpes Simplex ; Herpes Zoster ; Humans ; Impetigo ; Incidence ; Kaposi Varicelliform Eruption ; Korea ; Molluscum Contagiosum ; Retrospective Studies ; Scabies ; Seasons ; Skin Diseases ; Skin Diseases, Infectious* ; Tinea ; Warts

BACKGROUND: Eczema herpeticum (EH) is caused by viral infection, usually with the herpes simplex virus (HSV), and most often occurs in patients with atopic dermatitis (AD). Although EH is a common dermatosis, predisposing factors are largely unknown, and there have been few clinical and epidemiologic studies in Korea. OBJECTIVE: This study evaluated the clinical characteristics of inpatients diagnosed with EH over the last 10 years. METHODS: We reviewed the medical records of 62 patients who were diagnosed with EH and were hospitalized at the Chonnam National University Hospital in Gwangju from January 2004 to July 2014. RESULTS: The ratio of male to female patients with EH was about 2:1, and the mean age at onset of EH was 25.3 (+/-17.3) years. In this study, AD (67.7%) was the most common preceding skin disorder, followed by nummular eczema (6.5%), and seborrheic dermatitis (3.2%). Patients with EH had other systemic symptoms such as fever (22.6%), headache (4.8%), and lymphadenopathy (4.8%). Patients with recurrent infection of HSV had longer hospitalizations compared to those with primary infection (9.35 vs. 6.49 days), but the difference was not significant (p=0.269). There was no significant difference in the number of hospitalized days between patients receiving antiviral agents vs. antibiotics (p=0.153). Systemic steroids were administered in 66.1% patients, which had no correlation with the number of hospitalized days (p=0.203). CONCLUSION: The present retrospective analysis contributes to our understanding of the clinical characteristics of EH.
Anti-Bacterial Agents ; Antiviral Agents ; Causality ; Dermatitis, Atopic ; Dermatitis, Seborrheic ; Eczema* ; Epidemiologic Studies ; Female ; Fever ; Gwangju ; Headache ; Hospitalization ; Humans ; Inpatients* ; Jeollanam-do ; Kaposi Varicelliform Eruption* ; Korea ; Lymphatic Diseases ; Male ; Medical Records ; Retrospective Studies ; Simplexvirus ; Skin ; Skin Diseases ; Steroids

Female ; Humans ; Kaposi Varicelliform Eruption ; diagnosis ; etiology ; Middle Aged ; Rosacea ; drug therapy ; Tacrolimus ; adverse effects ; therapeutic use