What is Eczema Herpeticum?

Eczema herpeticum represents widespread cutaneous HSV in patients with pre-existing skin disorders. Eczema herpeticum is also known as Kaposi's Varicelliform Eruption. Atopic Dermatitis is by far the most common underlying skin condition. Other skin conditions that predispose patients to this primary HSV infection include:

Darier's Disease
Pemphigus foliaceous
Icthyosis vulgaris

The patient often presents with clusters of umbilicated vesicles appearing on abnormal or even apparently normal skin. The eruption then spreads over the following 7 to 10 days, and the umbilicated vesicles evolve into classic discrete "punched-out" small erosions. Typically, the patient experiences fever, malaise, and generalized lymphadenopathy. The vesicles may break down and coalesce into large erosions that have a tendency to be complicated by secondary infection. The course of this condition is usually 2 to 6 weeks. Recurrent episodes may occur, but the clinical presentation is typically milder.

The differential diagnosis may include widespread impetigo (and, indeed, some cases may become secondarily impetiginized). Kaposi's varicelliform eruption secondary to vaccinia virus is far less likely.

The diagnosis is made by history and the clinical presentation. Tzanck preparation is a useful confirmatory test, and viral culture may be helpful in more subtle cases.

Therapy of eczema herpeticum is 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, typically with oral antibiotics offering staphylococcal and streptococcal coverage. Inpatient management with intravenous acyclovir or antibiotic coverage may be required, especially in infants with high fever, poor oral intake, and evidence of secondary infection.

For to view pictures of Eczema herepticum, visit:
http://www.bu.edu/cme/modules/2002/herpes02/content/4-phsi-e.htm