Eczema herpeticum

OVERVIEW

  • Disseminated viral infection characterized by fever, lymphadenopathy, and acute eruption of painful, monomorphic clustered vesicles
  • Most often seen as a complication of atopic dermatitis/eczema
  • Most cases due to HSV-1 or HSV-2
  • Eczema herpeticum is one of the few dermatological emergencies

CLINICAL FEATURES

  • Fever
  • Lymphadenopathy
  • Malaise
  • Skin lesions:
    • Clusters of monomorphic itchy and painful blisters, most often on face and neck
    • New patches form and spread over 7-10 days
    • May be filled with clear yellow fluid or thick purulent material
    • Often blood-stained
    • Older blisters crust over and form erosions
    • Lesions heal over 3-6 weeks

INVESTIGATIONS

  • Blister scrapings for viral culture and/or PCR
  • Bacterial swab for MCS as eczema herpeticum can resemble impetigo, and may be complicated by secondary bacterial infection

MANAGEMENT

  • Oral acyclovir 400-800mg 5 times daily; or valaciclovir 1g BD, for 10-14 days or until lesions heal
  • Secondary bacterial skin infection requires antibiotic therapy
  • Topical steroids are not recommended
  • Ophthalmology review is required if eyelid or eye involvement is suspected

COMPLICATIONS

  • Secondary bacterial infection with staphylococci or streptococci causing impetigo and cellulitis
  • Severe cases may cause multi-organ involvement, including eyes, brain, lung and liver
  • Mortality is rare

CCC 700 6

Critical Care

Compendium

MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Adult/Paediatric Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner

Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

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