Eczema herpeticum

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Background

  • May be life-threatening

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 (5)
  • fever is common
  • Multiple organ systems can be involved, resulting in lymphadenopathy, keratoconjunctivitis and resulting blindness, meningitis, encephalitis, etc (4).
  • Lesions may become secondarily infected by bacteria, mainly with staph aureus (4).


  • <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
    • History of food allergies or asthma (4)
    • Larger surface area of eczema
    • Eczema of the head/neck
    • Increased levels of IgE


Differential Diagnosis

Herpes Simplex Virus-1

Evaluation

  • Clinical
  • Viral culture from swabs of wounds (5)
  • Tzanck smears showing multi-nucleated giant cells (5)
  • Direct Fluorescence antigen test for HSV (5)

Management

Disposition

See Also

External Links

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.