Eczema Herpeticum

Eczema herpeticum is a dermatological emergency which is usually a complication of atopic dermatitis, but can also be secondary to other skin conditions.

Pathophysiology

Eczema herpeticum is caused by herpes simplex virus 1 or 2 (HSV1/HSV2) and usually occurs after being in contact with another individual infected with HSV. It is thought that a break in the skin enables the entry of HSV, thus leading to eczema herpeticum.

Individuals with atopic dermatitis are usually affected, but people without eczema but other breaks in the skin e.g. people with burns can also be at risk due to the underlying pathogenesis of the disease. In instances where eczema herpeticum occurs when the patient doesn’t have an underlying eczema e.g. in burns, it’s more accurate to term the rash Kaposi varicelliform eruption.

Clinical Features

• Monomorphic (they all look similar), painful, itchy vesicles
• Can have red, purple or black appearances
• Usually affects the face and neck but can appear elsewhere
• Punched out erosions which can coalesce together to form a larger erosion
• Fever
• Malaise

Mohammad2018, CC BY-SA 4.0 , via Wikimedia Commons

Eczema Herpeticum Rash

Investigations

Viral swabs can be taken from the lesions to confirm the diagnosis.

Management

• Urgent oral or IV antivirals such as aciclovir are the treatment of choice
• Patients usually require same day dermatological review
• If the rash is involving the skin surrounding the eyes, the patient needs a same-day ophthalmological + dermatological referral alongside systemic aciclovir as there’s a risk of herpetic keratitis developing which can threaten vision.
• If a secondary bacterial infection occurs as well, antibiotics may be indicated

References

http://www.pcds.org.uk/clinical-guidance/eczema-eczema-herpeticum

https://nationaleczema.org/eczema/related-conditions/eczema-herpeticum/

https://dermnetnz.org/topics/eczema-herpeticum           

https://www.nice.org.uk/guidance/cg57/chapter/Recommendations#treatment-2