Atopic dermatitis causes a breakdown of the skin barrier, making people with the condition especially vulnerable to HSV-1 infections.
“Healthy skin acts as a protective barrier that helps keep viruses, bacteria, and other irritants out,” says Jody A. Levine, MD, a pediatric dermatologist in New York City. “In children with atopic dermatitis, that barrier is disrupted, leaving tiny cracks in the skin that make it easier for germs to enter.”
Though a cold sore can also be harmful to adults with moderate-to-severe eczema, children with the same type of atopic dermatitis are even more at risk when exposed to HSV-1.
That’s partly because children have developing immune systems and thinner skin barriers than adults, so they’re already at a higher risk of catching viruses and getting infections.
“If a child with eczema is exposed to HSV-1, the virus can spread rapidly through areas where the skin barrier is damaged,” says Dr. Levine. “Instead of remaining confined to a small cold sore on the lip, it can infect large areas of skin.”
What’s more, the skin’s immune defenses tend to be less effective in kids with atopic dermatitis than in children without the condition, making it even more difficult for them to fight off infections.
In short, “Children with moderate-to-severe eczema are at the greatest risk, because they have more extensive barrier disruption,” says Levine.
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