Eczema Herpeticum Flashcards

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1
Q

What is eczema herpeticum?

A

Eczema with co-existing herpes simplex infection

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2
Q

When is it most often seen?

A

As a complication of atopic dermatitis

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3
Q

What causes it?

A

Herpes simplex infection type 1 or 2

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4
Q

Who does it typically affect?

A

Can affect all ages, but most often in infants and children with atopic dermatitis

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5
Q

Why is it associated with atopic dermatitis?

A

Those with atopic dermatitis have reduced immunity to herpes infection

The underlying dermatitis can be mild, severe, active or inactive

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6
Q

Eczema herpeticum usual starts with…

A

Clusters of itchy and painful blisters

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7
Q

Where do the blisters typically appear?

A

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

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8
Q

What clinical features are associated?

A

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

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9
Q

How long does it take for lesions to heal?

A

2 to 6 weeks

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10
Q

Is it potentially life threatening?

A

Yes - child should be admitted

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11
Q

Secondary bacterial infection with staphylococcal or streptococci may lead to…

A

Impetigo and cellulitis

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12
Q

Are the lesions painful?

A

Yes

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13
Q

What systemic signs can be seen?

A

Fever
Generally unwell
Lymphadenopathy

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14
Q

What complications can occur?

A

Secondary bacterial infection

In severe cases - encephalitis, blindness, multi organ failure

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15
Q

How is it diagnosed?

A

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

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16
Q

Is eczema herpeticum infectious?

A

Yes - herpes is a very infectious virus - can easily catch it by touching the skin of someone with herpes

17
Q

What is the treatment for eczema herpeticum?

A

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

18
Q

How are the vesicles often described?

A

Punched out

19
Q

When will clinical features occur after contact with infected individual?

A

5-12 days

The individual may or may not have visible cold sores

20
Q

Can it spread to involve normal skin?

A

Yes, initially over areas affected by atopic dermatitis then spreads

21
Q

What can eczema herpetcum be mistaken for?

A

Impetigo

Chickenpox

22
Q

If HSV spreads to the eye, what can it cause?

A

Herpes simplex keratitis - can cause dendritic ulcers