16th July 2026

Eczema Herpeticum

Figure 1: Child with facial eczema herpeticum.

Image Source: Wikimedia Commons (2020), ECG AVNRT, Licenced under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/File:Eczema_herpitcum.jpg (Accessed: 24 May 2026).

Clinical features

Eczema Herpeticum is commonly seen as a complication of atopic dermatitis. It is characterised by monomorphic painful and itchy blisters with punched out lesions, and new blisters have a central dimple (umbilication). It is caused by Herpes Simplex Virus(HSV)Type 1 or 2. It can also happen in non-eczematous conditions such as thermal burns and psoriasis. The patient can be very unwell and present with fever and swollen lymph nodes. Eye involvement will require urgent ophthalmology attention. 

Investigations

• Viral swabs 
• Bacterial swabs
• Rule out secondary infection.

Management 

• Oral antiviral, e.g., Aciclovir 400mg, five times a day 
• Oral antibiotics if secondary bacterial infection 
• Topical steroids generally NOT recommended unless there is active underlying atopic dermatitis that requires treatment