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Top Tip n° 27 Why: How: What next and when: Where else: References: Who are you: Review date: Review due: Top Tips in Two Minutes: Eczema Herpeticum Eczema Herpeticum (also known as Kaposi varicelliform eruption) is the development of widespread cutaneous HSV (Herpes simplex virus) infection in a patient with eczema. In children it is commonly a primary HSV infection (majority HSV-1). It is important to recognise eczema herpeticum so that appropriate treatment can be given promptly and potentially serious sequelae avoided. If diagnosed early treatment can be given successfully in primary care. Eczema Herpeticum arises on the background of atopic eczema (although it does not have to be severe) and occurs in children and adults. History The onset is usually fairly rapid over a few days Sudden deterioration of the eczema Child is usually ‘grizzly’ There may a history of contact with HSV (cold sore) Clinical Lesions start as vesicles but due to itch these may be replaced by crusted lesions or punched-out erosions. Pustules may also be present. Lesions may be discrete or confluent and any site can be affected but limbs typically involved Pyrexia in up to 75%. Associated clinical symptoms include: intense itching, malaise, vomiting, and lymphadenopathy. Secondary bacterial infection usually present. If possible, swab skin from affected site for viral and bacterial culture. Stop topical steroids and wet wraps/bandages. If child is not systemically unwell and lesions are localised, treat with oral aciclovir (do not wait for swab results). Treat any secondary bacterial infection with oral flucloxacillin. If unwell or extensive lesions, urgent referral to hospital for IV acyclovir. Contact on call dermatologist/paediatrician. Complications Can become fulminant if not treated Eye involvement - seek urgent ophthalmological opinion if lesions near the eye Recurrences common (20%) in first few months Contact on call Dermatology SpR or Consultant http://www.dermnetnz.org/viral/herpes-simplex.html http://emedicine.medscape.com/article/1132622-overview rd Goodyear HM. Harper’s Textbook of Paediatric Dermatology 3 Edn 2011.Eds Irvine, Hoeger, Yan Dr Nigel Burrows, Consultant Dermatologist February 2012 February 2014