Eczema herpeticum

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
  • Treatment to cover Staph and Strep
  • 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

Disposition

See Also

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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