6th July 2023

Eczema Herpeticum

A widespread and severe HSV infection of the skin that is mostly associated with atopic eczema. This is a dermatological emergency. Eczema herpeticum usually presents during the first episode of HSV infection but can result from recurrent infection. It has also been seen in non-eczematous conditions such as pemphigus vulgaris, burns and Darier disease.

Eczema herpeticum manifests as clusters of painful and itchy monomorphic vesicles. These rupture leaving small punched-out erosions and ulcerations overlying an erythematous base. Patients often present with extensive vesicles over the face, neck or trunk with associated fever, malaise and lymphadenopathy. Lesions can take up to 6 weeks to heal.

Eczema herpeticum 

Image Source: Wikimedia Commons (2018). Eczema herpitcum, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/File:Eczema_herpitcum.jpg (Accessed on: 15 March 2023).

Diagnosis is usually clinical, however, a viral PCR swab can be taken for HSV. A bacterial swab should also be taken to exclude secondary bacterial infection. Prompt treatment is with oral aciclovir for 10-14 days or until lesions heal. IV aciclovir may be required if the patient is too unwell/deteriorating. An ophthalmologist should be consulted in suspected cases of eye involvement.