Eczema herpeticum: Difference between revisions

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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==
*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, mainly with 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
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<gallery>
<gallery>
File:Eczema Herpeticum picture.png|Eczema Herpeticum in immunocompromised patient.  Source: See references below (2).
File:Eczema Herpeticum picture.png|Eczema Herpeticum in immunocompromised patient.  Source: See references below<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| Eczema herpticum in child.  Source: see references below (4)
File: Eczema_Herpticum_picutre_2.jpg| Eczema herpticum in child.  Source: see references below<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>
</gallery>
</gallery>


==Differential Diagnosis==
==Differential Diagnosis==
{{HSV-1 DDX}}
{{HSV-1 DDX}}
*Impetigo
*[[Impetigo]]
*Eczema Vaccinatum (5)
*Eczema Vaccinatum
*Primary varicella infection (5)
*Primary [[varicella]] infection  


==Evaluation==
==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==
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*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.
*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-RESPIRAT'''OR'''Y SYNDROME IS A C'''OR'''RELATE OF ECZEMA HERPETICUM. Allergy. 2011;66(7):925-933. doi:10.1111/j.1398-9995.2010.02538.x.
*Hinz T, Zaccaro D, Byron M, et al. ATOPIC DERMO-RESPIRAT'''OR'''Y SYNDROME IS A C'''OR'''RELATE 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:Dermatology]]
[[Category:Dermatology]]
[[Category:ID]]
[[Category:ID]]

Revision as of 22:22, 27 September 2019

Background

Clinical Features

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


  • Eczema Herpeticum in immunocompromised patient. Source: See references below[7]).

  • Eczema herpticum in child. Source: see references below[8]

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. ↑ 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.
  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. ↑ Leung DYM. Why is eczema herpeticum unexpectedly rare? Antiviral research. 2013;98(2):153-157. doi:10.1016/j.antiviral.2013.02.010.
  5. ↑ 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.
  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.
  • 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.
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