2nd July 2023

Complications

Eczema Herpeticum (EH)

An important and rare risk of atopic eczema. It results from a secondary infection of eczema with HSV. The presenting rash appears as small, punched-out lesions on a background of recently worsening eczema history from the patient. EH is a dermatological emergency and should be managed with urgent admission to hospital and intravenous antivirals (acyclovir). In any suspicious case, swabs should be taken from the skin for microscopy and culture.

Eczema herpeticum showing the typical lesions of a secondary HSV infection in eczema.

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: 14 March 2023).

Erythroderma

Erythroderma is a severe condition that presents with diffuse erythema and scaling. To be classified as erythroderma it must involve all or most of the skin surface area – over 90% as per the most common definitions. There are various causes, but two of the most common are exacerbation of pre-existing dermatitis or psoriasis, and hypersensitivity to drugs. It can develop acutely over a few hours, or it can evolve over days. It presents as skin that is red and warm to touch, often with severe pain or itching. Over time scaling of the skin can occur and crusted lesions can develop, and this is often more common in those who have underlying psoriasis.

Management involves hospitalisation requiring close monitoring of haemodynamic status as well as body temperature and treatment of any secondary cutaneous superinfections. Oral antihistamines can reduce itching, whereas inflammation and pruritus can be managed with topical corticosteroids.