Viral skin infections in pediatric patients with atopic dermatitis – a single-center retrospective study

Introduction
Atopic dermatitis (AD) is a chronic pediatric skin disease characterized by pruritus, eczematous lesions, and xerosis, and is often complicated by infections of different etiopathology. This study analyzed the most frequent viral skin infections in children with AD admitted to the dermatology department.

Material and methods
This retrospective single-center study enrolled 77 pediatric patients aged 1–18 years with a diagnosis of AD and coexisting viral skin infections caused by the molluscum contagiosum virus (MCV), herpes simplex virus (HSV), human papillomavirus (HPV), or enteroviruses. Patients were recruited over a five-year period, from January 2018 to December 2022. Collected data included age, sex, patient distribution by year and month, and treatment strategies.

Results
The cohort consisted of 36 males (46.8%) and 41 females (53.2%). Among the viral infections, those caused by MCV were the most prevalent, accounting for 49.4% of cases, while HPV infections were the least common, representing 9.1%. Although no statistically significant differences were found in the monthly distribution of infections, notable variations were observed between June and several other months. All patients with MCV infections underwent curettage. Only patients with HSV infections received systemic acyclovir therapy. Ten patients (13.0%) were treated with advanced therapies for AD, including cyclosporine, methotrexate, dupilumab, or phototherapy.

Conclusions
Viral skin infections are a clinically significant comorbidity in pediatric patients with AD, most commonly caused by the molluscum contagiosum virus. The highest incidence was observed in 2018, while the decline in 2019–2020 was likely influenced by the COVID-19 pandemic and related lockdown measures. Treatment strategies varied depending on the viral etiology, with MCV managed by curettage, while HSV was treated with systemic acyclovir. Eczema herpeticum was associated with a more severe disease course, emphasizing the need for early recognition and prompt antiviral therapy. These findings highlight the importance of individualized, etiology-driven management in pediatric patients with AD and viral skin infections.