Smallpox vaccine and eczema

This article discusses how the newest smallpox vaccine has been approved for testing in patients with eczema or atopic dermatitis.

Between 1 and 6 percent of patients vaccinated with the original smallpox vaccine had eczema vaccinatum (EV), where the live virus vaccine actually caused a smallpox infection. The mortality rate for EV is 1%. This article explains why people with atopic dermatitis may have this response. The vaccine is administered via the lower epidermis, which has proven to have the best immune response. Individuals with atopic dermatitis have an altered epidermis that does not produce the same quantity of anti viral and anti bacterial proteins. Further, with the dermatitis, there is an exagerrated Th2 response, but Th1 cells are the primary cell-mediated immune cells. Basically, patients with atopic dermatitis could not safely be vaccinated with the original vaccine. In fact, exposure to someone who was vaccinated was enough to give some patients EV. Because over 50% of the population has eczema or comes in direct contact with someone who does, it is an important step for a vaccine to reduce the risk of EV.

Engler RJ, Kenner J, Leung DY. Smallpox vaccination: Risk considerations for patients with atopic dermatitis. J Allergy Clin Immunol. 2002 Sep;110(3):357-65.