Eczema Herpeticum Flashcards
What is eczema herpeticum?
Eczema with co-existing herpes simplex infection
When is it most often seen?
As a complication of atopic dermatitis
What causes it?
Herpes simplex infection type 1 or 2
Who does it typically affect?
Can affect all ages, but most often in infants and children with atopic dermatitis
Why is it associated with atopic dermatitis?
Those with atopic dermatitis have reduced immunity to herpes infection
The underlying dermatitis can be mild, severe, active or inactive
Eczema herpeticum usual starts with…
Clusters of itchy and painful blisters
Where do the blisters typically appear?
Can be anywhere, but often face and neck
Can occur on normal skin or sites of active or previously active atopic dermatitis
New patches for and spread over 7-10 days
What clinical features are associated?
Monomorphic blisters filled with clear yellow or purulent material
Often blood stained
New blisters have central dimples - umbilication
May weep or bleed
Old blisters crusty over and form erosions
How long does it take for lesions to heal?
2 to 6 weeks
Is it potentially life threatening?
Yes - child should be admitted
Secondary bacterial infection with staphylococcal or streptococci may lead to…
Impetigo and cellulitis
Are the lesions painful?
Yes
What systemic signs can be seen?
Fever
Generally unwell
Lymphadenopathy
What complications can occur?
Secondary bacterial infection
In severe cases - encephalitis, blindness, multi organ failure
How is it diagnosed?
Clinically - when a patient with known atopic dermatitis presents with an acute eruption of painful clustered vesicles associated with fever and malaise
Swab base of fresh blister for laboratory testing
Is eczema herpeticum infectious?
Yes - herpes is a very infectious virus - can easily catch it by touching the skin of someone with herpes
What is the treatment for eczema herpeticum?
An emergency
Prompt treatment with antivirals
Oral aciclovir 500-800mg 5 times a day or valaciclovir 1g BD for 10-14 days or until lesions heal
IV aciclovir if too unwell to take tablets or if infection deteriorating despite treatment
Secondary bacterial infection - systemic antibiotics
Topical steroids not recommended
How are the vesicles often described?
Punched out
When will clinical features occur after contact with infected individual?
5-12 days
The individual may or may not have visible cold sores
Can it spread to involve normal skin?
Yes, initially over areas affected by atopic dermatitis then spreads
What can eczema herpetcum be mistaken for?
Impetigo
Chickenpox
If HSV spreads to the eye, what can it cause?
Herpes simplex keratitis - can cause dendritic ulcers
