Eczema herpeticum

Eczema herpeticum, also known as Kaposi's varicelliform eruption, represents widespread cutaneous HSV in patients with pre-existing skin disorders. Atopic Dermatitis is by far the most common underlying skin condition. Other skin conditions that predispose patients to this primary HSV infection include: Darier disease, pemphigus foliaceous and icthyosis vulgaris. The differential diagnosis may include widespread impetigo. The diagnosis is made by history and the clinical presentation. Tzanck preparation is a useful confirmatory test, and viral culture may also be helpful.
Eczema herpeticum is treated with oral acyclovir 200 mg 5 times daily. Burow's soaks 2 or 3 times daily may be useful for vesicular areas. Early and aggressive therapy of secondary infection is necessary. Infants with high fever, poor oral intake, and evidence of secondary infection, may require inpatient management with intravenous acyclovir or antibiotic coverage. How often do you see eczema herpeticum in your practice? Can you appreciate an underlying skin condition in all such cases? View images

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