Eczema herpeticum

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
• 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, including 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

• 

  Eczema Herpeticum in immunocompromised patient. Source: See references below (2).

• 

  Eczema herpticum in child. Source: see references below (4)

Differential Diagnosis

Herpes Simplex Virus-1

• Eczema herpeticum
• Herpes gingivostomatitis
• Herpes keratitis
• Herpes labialis (cold sore)
• Herpes simplex encephalitis
• Herpetic whitlow

Diagnosis

• 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

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.