eczema herpeticum

• Eczema herpeticum:

  • Viral skin infection caused by the herpes simplex virus or varicella zoster virus
  • HSV-1 is the most common causative organism, and may be associated with a coldsore in the patient or close contact
  • Usually occurs in a patient with a pre-existed skin condition - most commonly atopic dermatitis
  • Virus is able to enter the skin and cause an infection
• Presentation:

  • Patient who suffers with eczema that has developed a widespread, painful, vesicular rash
  • Systemic symptoms - fever, lethargy, irritability and reduced appetite
  • Usually there is lymphadenopathy
• Blisters:

  • Blisters are monomorphic
  • May be filled with clear yellow fluid or thick purulent material
  • Often blood stained e.g. red, purple or black
  • New blisters have central dimples (umbilication)
  • They may weep or bleed
  • Older blisters crust over and form sores
  • Lesions heal over 2-6 weeks
  • In severe cases where the skin has been destroyed by infection - small white scars may persist long term
• Severe eczema herpeticum may affect multiple organs, including the eyes, brain, lung, and liver. It can rarely be fatal.
• Diagnosis:

  • Can be diagnosed clinically
  • Viral swabs can confirm the infection - scraping the base of a fresh blister
  • Bacterial swabs should also be taken as eczema herpeticum may resemble impetigo and can be complicated by secondary bacterial infection
• Treatment:

  • Considered dermatological emergency
  • Prompt treatment with antiviral medication should eliminate the need for hospital admission
  • Oral aciclovir 5 times daily, for 10-14 days until lesions heal
  • IV aciclovir is needed if patient unable to take tablets or the infection is not responding to oral treatment
  • Antibiotics if secondary bacterial skin infection suspected
  • Topical steroids may be used
  • Consult ophthalmologist when eyelid or eye involvement