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Eczema herpeticum
From WikEM
Contents
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
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
- Herpes gingivostomatitis
- Herpetic whitlow
- Herpes labialis (cold sore)
- Herpes keratitis
- Eczema herpeticum
- Impetigo
- Eczema Vaccinatum (5)
- Primary varicella infection (5)
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
- 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
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.
