Eczema Herpeticum

About Eczema Herpeticum

Eczema herpeticum is a potentially serious viral infection caused by herpes simplex virus HSV in patients with preexisting skin conditions, particularly atopic dermatitis eczema. The compromised skin barrier in eczema allows HSV to spread more easily, causing a rapidly progressing rash with clustered vesicles and punched out erosions that may cover large areas of skin. Unlike typical eczema which is itchy, eczema herpeticum may be painful. Fever, malaise, and lymphadenopathy may accompany the rash. The condition can be severe, particularly in infants and immunocompromised patients. Complications include bacterial superinfection with Staphylococcus aureus, herpes keratitis if the eye is involved, and systemic dissemination. Diagnosis is made clinically, confirmed by viral PCR, Tzanck smear showing multinucleated giant cells, or viral culture. Treatment requires systemic antiviral therapy acyclovir or valacyclovir, oral for mild cases and intravenous for severe cases. Early treatment is critical to prevent dissemination, so suspected eczema herpeticum needs same day medical assessment. Ophthalmology consultation is needed if eye involvement is suspected. Most cases resolve within 2 to 6 weeks with treatment. Recurrence is common. Clinicians and caregivers watch for this complication in people with eczema, particularly when family members have cold sores.