Download Top Tips in Two Minutes: Eczema Herpeticum Why: Eczema

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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