Difference between revisions of "Eczema herpeticum"

(Clinical Features)
 
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==Background==
 
==Background==
 +
*Diffuse [[HSV]] infection occurring in 3% of patients patients with [[atopic dermatitis]]<ref>Leung DYM. Why is eczema herpeticum unexpectedly rare? Antiviral research. 2013;98(2):153-157. doi:10.1016/j.antiviral.2013.02.010.</ref>
 
*May be life-threatening
 
*May be life-threatening
  
 
==Clinical Features==
 
==Clinical Features==
 +
[[File:Eczema Herpeticum picture.png|thumb|Eczema Herpeticum in immunocompromised patient.<ref>Bagazgoitia L, Beà S, Garate M, Moreno R, Jaén P. ECZEMA HERPETICUM IN A PATIENT WITH TERMINAL RENAL FAILURE UNDER NARROW-BAND UVB THERAPY. Indian Journal of Dermatology. 2010;55(2):200-201. doi:10.4103/0019-5154.62744.</ref>).]]
 +
[[File: Eczema_Herpticum_picutre_2.jpg|thumb|Eczema herpticum in child.<ref>Leung DYM. Why is eczema herpeticum unexpectedly rare? Antiviral research. 2013;98(2):153-157. doi:10.1016/j.antiviral.2013.02.010.</ref>]]
 
*Development of vesicular eruptions containing HSV 1 or 2 in areas of epidermis previously affected by atopic dermatitis
 
*Development of vesicular eruptions containing HSV 1 or 2 in areas of epidermis previously affected by atopic dermatitis
*Lesions may appear similar to impetigo (5)
+
*Lesions may appear similar to impetigo<ref>Liaw F-Y, Huang C-F, Hsueh J-T, Chiang C-P. Eczema herpeticum: A medical emergency. Canadian Family Physician. 2012;58(12):1358-1361.</ref>
*fever is common
+
*[[Fever]] is common
*Multiple organ systems can be involved, resulting in lymphadenopathy, keratoconjunctivitis and resulting blindness, meningitis, encephalitis, etc (4).
+
*Multiple organ systems can become involved, resulting in [[lymphadenopathy]], [[keratoconjunctivitis]] (potentially sight-threatening),[[meningitis]], [[encephalitis]], etc <ref>Leung DYM. Why is eczema herpeticum unexpectedly rare? Antiviral research. 2013;98(2):153-157. doi:10.1016/j.antiviral.2013.02.010.</ref>.
*Lesions may become secondarily infected by bacteria, including staph aureus (4).  
+
*Lesions may become secondarily infected by bacteria, mainly with staph aureus<ref>Leung DYM. Why is eczema herpeticum unexpectedly rare? Antiviral research. 2013;98(2):153-157. doi:10.1016/j.antiviral.2013.02.010.</ref>.  
 
+
*The following is associated with increased susceptibility to Eczema Herpeticum<ref>Bagazgoitia L, Beà S, Garate M, Moreno R, Jaén P. ECZEMA HERPETICUM IN A PATIENT WITH TERMINAL RENAL FAILURE UNDER NARROW-BAND UVB THERAPY. Indian Journal of Dermatology. 2010;55(2):200-201. doi:10.4103/0019-5154.62744.</ref>:
 
 
*<3% of Eczema patients develop Eczema Herpeticum (4).  
 
 
 
* The following is associated with increased susceptibility to Eczema Herpeticum (2):
 
 
**Early age of onset of eczema
 
**Early age of onset of eczema
**History of food allergies or asthma (4)
+
**History of food allergies or asthma<ref>Leung DYM. Why is eczema herpeticum unexpectedly rare? Antiviral research. 2013;98(2):153-157. doi:10.1016/j.antiviral.2013.02.010.</ref>
 
**Larger surface area of eczema
 
**Larger surface area of eczema
 
**Eczema of the head/neck
 
**Eczema of the head/neck
 
**Increased levels of IgE
 
**Increased levels of IgE
 
 
<gallery>
 
File:Eczema Herpeticum picture.png|Eczema Herpeticum in immunocompromised patient.  Source: See references below (2).
 
File: Eczema_Herpticum_picutre_2.jpg| Eczema herpticum in child.  Source: see references below (4)
 
</gallery>
 
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
 
{{HSV-1 DDX}}
 
{{HSV-1 DDX}}
 +
*[[Impetigo]]
 +
*Eczema Vaccinatum
 +
*Primary [[varicella]] infection
  
==Diagnosis==
+
==Evaluation<ref>Liaw F-Y, Huang C-F, Hsueh J-T, Chiang C-P. Eczema herpeticum: A medical emergency. Canadian Family Physician. 2012;58(12):1358-1361.</ref>==
 
*Clinical
 
*Clinical
*Viral culture from swabs of wounds (5)
+
*Viral culture from swabs of wounds
*Tzanck smears showing multi-nucleated giant cells (5)
+
*Tzanck smears showing multi-nucleated giant cells  
*Direct Fluorescence antigen test for HSV (5)
+
*Direct Fluorescence antigen test for HSV
  
 
==Management==
 
==Management==
 
*Treatment to cover [[Staph]] and [[Strep]]
 
*Treatment to cover [[Staph]] and [[Strep]]
*[[Bactrim]] 10mg/kg/d in 2 divided doses OR [[clindamycin]] 24mg/kg/d divided into 3 doses x10d
+
*[[Bactrim]] 10mg/kg/d in 2 divided doses '''OR''' [[clindamycin]] 24mg/kg/d divided into 3 doses x10d
*[[Acyclovir]] 80mg/kg/d in 3 divided doses x10
+
*[[Acyclovir]] 80mg/kg/d in 3 divided doses x10<ref>Aronson PL, Yan AC, Mittal MK, Mohamad Z, Shah SS. Delayed Acyclovir and Outcomes of Children Hospitalized With Eczema Herpeticum. Pediatrics. 2011;128(6):1161-1167. doi:10.1542/peds.2011-0948.</ref>
  
 
==Disposition==
 
==Disposition==
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==References==
 
==References==
 
<references/>
 
<references/>
* Aronson PL, Yan AC, Mittal MK, Mohamad Z, Shah SS. Delayed Acyclovir and Outcomes of Children Hospitalized With Eczema Herpeticum. Pediatrics. 2011;128(6):1161-1167. doi:10.1542/peds.2011-0948.
 
*Bagazgoitia L, Beà S, Garate M, Moreno R, Jaén P. ECZEMA HERPETICUM IN A PATIENT WITH TERMINAL RENAL FAILURE UNDER NARROW-BAND UVB THERAPY. Indian Journal of Dermatology. 2010;55(2):200-201. doi:10.4103/0019-5154.62744.
 
*Hinz T, Zaccaro D, Byron M, et al. ATOPIC DERMO-RESPIRATORY SYNDROME IS A CORRELATE OF ECZEMA HERPETICUM. Allergy. 2011;66(7):925-933. doi:10.1111/j.1398-9995.2010.02538.x.
 
*Leung DYM. Why is eczema herpeticum unexpectedly rare? Antiviral research. 2013;98(2):153-157. doi:10.1016/j.antiviral.2013.02.010.
 
*Liaw F-Y, Huang C-F, Hsueh J-T, Chiang C-P. Eczema herpeticum: A medical emergency. Canadian Family Physician. 2012;58(12):1358-1361.
 
  
[[Category:Derm]]
+
[[Category:Dermatology]]
 
[[Category:ID]]
 
[[Category:ID]]

Latest revision as of 22:13, 10 September 2020

Background

Clinical Features

Eczema Herpeticum in immunocompromised patient.[2]).
Eczema herpticum in child.[3]
  • Development of vesicular eruptions containing HSV 1 or 2 in areas of epidermis previously affected by atopic dermatitis
  • Lesions may appear similar to impetigo[4]
  • Fever is common
  • Multiple organ systems can become involved, resulting in lymphadenopathy, keratoconjunctivitis (potentially sight-threatening),meningitis, encephalitis, etc [5].
  • Lesions may become secondarily infected by bacteria, mainly with staph aureus[6].
  • The following is associated with increased susceptibility to Eczema Herpeticum[7]:
    • Early age of onset of eczema
    • History of food allergies or asthma[8]
    • Larger surface area of eczema
    • Eczema of the head/neck
    • Increased levels of IgE

Differential Diagnosis

Herpes Simplex Virus-1

Evaluation[9]

  • Clinical
  • Viral culture from swabs of wounds
  • Tzanck smears showing multi-nucleated giant cells
  • Direct Fluorescence antigen test for HSV

Management

Disposition

See Also

External Links

References

  1. Leung DYM. Why is eczema herpeticum unexpectedly rare? Antiviral research. 2013;98(2):153-157. doi:10.1016/j.antiviral.2013.02.010.
  2. Bagazgoitia L, Beà S, Garate M, Moreno R, Jaén P. ECZEMA HERPETICUM IN A PATIENT WITH TERMINAL RENAL FAILURE UNDER NARROW-BAND UVB THERAPY. Indian Journal of Dermatology. 2010;55(2):200-201. doi:10.4103/0019-5154.62744.
  3. Leung DYM. Why is eczema herpeticum unexpectedly rare? Antiviral research. 2013;98(2):153-157. doi:10.1016/j.antiviral.2013.02.010.
  4. Liaw F-Y, Huang C-F, Hsueh J-T, Chiang C-P. Eczema herpeticum: A medical emergency. Canadian Family Physician. 2012;58(12):1358-1361.
  5. Leung DYM. Why is eczema herpeticum unexpectedly rare? Antiviral research. 2013;98(2):153-157. doi:10.1016/j.antiviral.2013.02.010.
  6. Leung DYM. Why is eczema herpeticum unexpectedly rare? Antiviral research. 2013;98(2):153-157. doi:10.1016/j.antiviral.2013.02.010.
  7. Bagazgoitia L, Beà S, Garate M, Moreno R, Jaén P. ECZEMA HERPETICUM IN A PATIENT WITH TERMINAL RENAL FAILURE UNDER NARROW-BAND UVB THERAPY. Indian Journal of Dermatology. 2010;55(2):200-201. doi:10.4103/0019-5154.62744.
  8. Leung DYM. Why is eczema herpeticum unexpectedly rare? Antiviral research. 2013;98(2):153-157. doi:10.1016/j.antiviral.2013.02.010.
  9. Liaw F-Y, Huang C-F, Hsueh J-T, Chiang C-P. Eczema herpeticum: A medical emergency. Canadian Family Physician. 2012;58(12):1358-1361.
  10. Aronson PL, Yan AC, Mittal MK, Mohamad Z, Shah SS. Delayed Acyclovir and Outcomes of Children Hospitalized With Eczema Herpeticum. Pediatrics. 2011;128(6):1161-1167. doi:10.1542/peds.2011-0948.