Atopic Dermatitis and the Risk of Infections

Pavankumar Kamat


November 14, 2021


  • Atopic dermatitis (AD) was associated with an increased risk of hospitalised infections, opportunistic infections and several herpesvirus infections in both children and adults, with the risk being greatest in those with severe skin disease.

  • The increased risks of these infections were independent of immunosuppressive medication use for AD.

Why this matters

  • Findings add to the literature by analysing multiple additional types of infections and focusing on incident infections after AD diagnosis.

Study design

  • A retrospective cohort study included 409,431 patients with AD and 1,809,029 matched participants without AD, identified using data from The Health Improvement Network (THIN) database.

  • Primary outcomes: herpesvirus infections (cytomegalovirus [CMV], Epstein-Barr virus [EBV], herpes simplex virus [HSV] and varicella-zoster virus [VZV]), hospitalised infections and opportunistic infections.

  • Funding: Pfizer.

Key results

  • Children with AD had a greater risk of CMV (adjusted HR [aHR], 2.50; 95% CI, 1.38-4.54), HSV (aHR, 1.52; 95% CI, 1.48-1.56) and VZV (aHR, 1.33; 95% CI, 1.32-1.35), and the risk increased in a ‘dose-dependent’ manner with worsening AD severity.

  • The risk of EBV was slightly higher in children with mild AD (aHR, 1.09; 95% CI, 1.04-1.16) but was lower in children with moderate AD (aHR, 0.88; 95% CI, 0.78-0.99) and severe AD (aHR, 0.57; 95% CI, 0.42-0.78).

  • Children with AD vs those without had a higher risk of hospitalised infection (aHR, 1.40; 95% CI, 1.38-1.43), and the risk was higher in those with moderate AD (aHR, 1.86; 95% CI, 1.77-1.95) and severe AD (aHR, 2.01; 95% CI, 1.84-2.19).

  • Adults with AD had an increased risk of HSV (aHR, 1.50; 95% CI, 1.46-1.53) and VZV (aHR, 1.18; 95% CI, 1.16-1.19) across all severity levels, with the highest risk observed in those with severe AD.

  • AD was associated with a greater risk of EBV (aHR, 1.13; 95% CI, 1.03-1.24) but this was primarily driven by severe AD (aHR, 1.54; 95% CI, 1.09-2.19).

  • AD was not associated with an increased risk of opportunistic infections in children but was associated with a higher risk of opportunistic infections in adults (aHR, 1.31; 95% CI, 1.20-1.42).

  • Results remained consistent after excluding patients receiving immunosuppressive treatments for AD.


  • Retrospective design.


Wan J, Shin DB, Syed MN, Abuabara K, Lemeshow AR, Gelfand JM. Risk of herpesvirus, serious, and opportunistic infections in atopic dermatitis: a population-based cohort study. Br J Dermatol. 2021 Nov 08 [Epub ahead of print]. doi: 10.1111/bjd.20887. PMID: 34748650  View abstract 

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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