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eczema herpeticum
Etiology:
- Herpes simplex
- atopy, atoptic dermatitis
Epidemiology:
- occurs in infants & adults
Clinical manifestations:
- rapid onset of diffuse cutaneous Herpes simplex
- diffuse eruption of pruritic, umbilicated, erythematous vesicles with erosion & crusting
- vesicles may rupture to form erosions & coalesce to form larger ulcerations
- lesions develop on areas of pre-existing atopic dermatitis
- face, neck, upper torso
- lesions can spread to areas of normal skin within 1 week
- systemic manifestations of fever, malaise & lymphadenopathy may occur [3]
* images [2]
Laboratory:
- cytology of unroofed vesicle shows giant, ballooned keratinocytes
- direct fluorescent antibody test for HSV
- Herpes simplex virus 1 Ag in tissue
- Herpes simplex virus 2 Ag in tissue
Complications:
- bacterial superinfection
- can be life-threatening
Differential diagnosis:
- impetigo, bullous impetigo
- scabies
- eczema vaccinatum
- primary varicella infection
Management:
1) if severe or systemic symptoms medical emergency, especially in young infants
- systemic treatment with acyclovir or valacyclovir [3]
2) no systemic symptoms
- oral acyclovir or valacyclovir [3]
Related
Herpes simplex (HSV) or Herpes hominis
General
atopic dermatitis (atopic eczema)
skin infection
Herpes virus infection
References
- Ferri's Clinical Advisor, Instant Diagnosis and Treatment,
Ferri FF (ed), Mosby, Philadelphia, 2003
- Micali G, Lacarrubba F. (images)
Eczema Herpeticum.
N Engl J Med 2017; 377:e9. August 17, 2017
PMID: 28813215
http://www.nejm.org/doi/full/10.1056/NEJMicm1701668
- NEJM Knowledge+ Dermatology
- Traidl S, Roesner L, Zeitvogel J, Werfel T.
Eczema herpeticum in atopic dermatitis.
Allergy. 2021 Oct;76(10):3017-3027.
PMID: 33844308 Review.