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Eczema Herpeticum

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Eczema Herpeticum, Kaposi Varicelliform Eruption

  • See Also
  1. Herpes Simplex Virus
  2. Atopic Dermatitis
  • Epidemiology
  1. Age
    1. More common in children (immature Immune Systems)
  • Pathophysiology
  1. Skin infected by Herpes Simplex Virus infection
  2. Infections are typically in patients with skin barrier defects (see risk factors as below)
  • Risk Factors
  1. Atopic Dermatitis
  2. Burn Injury
  3. Post-operative complication (e.g. Cosmetic dermatology procedure)
  4. Inflammatory skin conditions
  • Symptoms
  1. Painful papulovesicular rash spread over localized skin region
  • Signs
  1. Characteristics
    1. Disseminated non-grouped Vesicles on an erythematous base
    2. Vesicles may develop into erosions after 2-7 days
    3. Crusts may overly lesions
    4. Lesion may require 2-6 weeks to resolve
  2. Distribution
    1. May affect any region with Atopic Dermatitis
    2. Head
    3. Face
    4. Neck
    5. Chest
  3. Severity
    1. Atopic Dermatitis severity correlates with Eczema Herpeticum severity
    2. Children are prone to more severe cases
  4. Associated findings
    1. Fever
    2. Lymphadenopathy
    3. Other systemic herpetic complications
      1. Herpes Simplex Keratitis (Keratoconjunctivitis)
      2. Herpes Gingivostomatitis
      3. HSV Encephalitis (Meningoencephalitis)
  • Labs
  1. HSV PCR
  2. Other laboratory testing as indicated (e.g. septic workup with Blood Cultures)
  3. Consider MRSA swabs (if superinfection suspected)
  • Differential Diagnosis
  1. See Vesicle
  2. Impetigo
  3. Hand Foot and Mouth Disease
  4. Varicella Zoster Virus
  5. Herpes gladiatorum
  • Complications
  1. Skin superinfections (e.g. MSSA or MRSA)
  • Management
  1. Dermatologic emergency requiring prompt initiation of Antiviral therapy
    1. Consult dermatology
  2. Inpatient management is typical with IV Antivirals (esp. children)
    1. Initiate IV Acyclovir (and follow Renal Function)
    2. Transition to oral Acyclovir or Valacyclovir
    3. Treat superinfections (e.g. MSSA, MRSA)
  3. Symptomatic management
    1. Skin Emollients (e.g. petroleum jelly)
    2. Topical antibacterial as needed (e.g. Mupirocin)
    3. Medium potency Topical Corticosteroids may be considered (e.g. Triamcinolone cream)
  • References
  1. Laporte (2025) Crit Dec Emerg Med 39(12): 16-7 [PubMed]