Eczema herpeticum

Blanter M, et al. Eczema herpeticum: would you know it if you saw it? Pediatr Emerg Care. 2015 Aug;31(8):586-8.

Eczema herpeticum is an easily missed entity most commonly seen in the pediatric population and carries the risk of systemic compromise and a 10% mortality rate. Clinicians should maintain high clinical suspicion when encountering children or young adults with a history of atopic dermatitis or other erosive dermatoses and who present with vesicular lesions, punched-out erosions, and systemic symptoms. We present 3 severe cases of eczema herpeticum that were potentially overlooked and demonstrate the need for elevated awareness to avoid potential pitfalls.

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Khan A, et al. Fifteen-minute consultation: eczema herpeticum in a child. Arch Dis Child Educ Pract Ed. 2015 Apr;100(2):64-8.

Eczema herpeticum (EH) occurs when there is secondary skin infection with herpes simplex virus in an atopic patient. The patient may not have unusually severe or active eczema. It is thought that the abnormal skin barrier function predisposes to infection, which can spread rapidly. Viraemia and secondary septicaemia can occur, and the condition can be life-threatening. The first episode of herpes infection is usually the worst and requires systemic treatment. Early recognition is vital. The presentation may be difficult to distinguish from secondary bacterial infection, which is common in eczema. A useful clinical clue is the presence of many very similar shaped and sized eroded lesions. Intact blisters may not be seen due to scratching. A rapid deterioration in eczema in a child who is systemically unwell should prompt consideration of EH.

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Luca NJ, et al. Eczema herpeticum in children: clinical features and factors predictive of hospitalization. J Pediatr. 2012 Oct;161(4):671-5.

This study characterizes a large cohort of pediatric patients with eczema herpeticum, including their clinical features and outcomes, and identifies factors associated with hospital admission, early disease recurrence, and repeat episodes. We found that hospitalization was significantly more likely in patients 1 year of age or less, males, and those with fever or systemic symptoms at presentation. In addition, repeat episodes were more likely to occur in patients requiring hospitalization and those with a history of prior episode(s) of eczema herpeticum.

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Frisch S, Siegfried EC. The clinical spectrum and therapeutic challenge of eczema herpeticum. Pediatr Dermatol. 2011 Jan-Feb;28(1):46-52.

We present 5 cases of eczema herpeticum in patients with severe recalcitrant atopic dermatitis to illustrate the range of possible clinical findings and supporting laboratory data that can obscure the diagnosis and complicate treatment. Major issues include: the need for aggressive laboratory evaluation (molecular diagnostics, viral cultures, skin biopsy, serology); the possibility of recurrent or chronic infection; the value of empiric antiviral therapy; the possibility of infection with thymidine-kinase resistant strains; and the importance of achieving control over the dermatitis with nonmyelosuppressive immunomodulating agents such as intravenous immunoglobulin or interferon gamma for dermatitis that requires systemic treatment.

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More PubMed results on eczema herpeticum.

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