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Adults With Atopic Dermatitis and Herpes Simplex and Topical Therapy With Tacrolimus: What Kind of Prevention?

Jann Lübbe, MD; Sabrina Sanchez-Politta, MD; Christophe Tschanz, MD; Jean-Hilaire Saurat, MD
Arch Dermatol. 2003;139(5):670-671. doi:10.1001/archderm.139.5.670.
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Eczema herpeticatum is well known as a complication associated with atopic dermatitis. We previously reported 2 cases that developed in adult patients during treatment of their atopic dermatitis with tacrolimus ointment.1 In a 1-year open study in adult patients with atopic dermatitis who were treated with tacrolimus ointment, eczema herpeticatum was observed at low frequencies (1.8%), but the data were insufficient to establish a causal relationship.2 Nevertheless, prevention is important, as the complication is potentially serious and may compromise a promising treatment alternative in a patient with atopic dermatitis.

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Unrecognized symptomatic herpes simplex in a 35-year-old man with atopic dermatitis and a negative herpes simplex history but a positive herpes simplex serologic test result. Such symptomatic viral recrudescences may remain unrecognized by the patient, increasing the risk of unintentional treatment with counterindicated medication, such as topical tacrolimus.

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