The blisters ooze pus when they break open, and then the lesions crust over. The EH rash heals in two to six weeks. It can leave scars. EH is most often caused by HSV It can also be caused by the genital herpes virus HVS-2, or some other viruses. EH usually erupts 5 to 12 days after contact with a person who has HSV. Children with eczema are the most common group to have EH.
But only a small percentage of children and others with eczema develop EH. People with severe or untreated eczema are more likely to be affected. Eczema damages the outer layer of your skin, leaving it dry, sensitive, and more vulnerable to infection.
Other suggested risk factors are the lack of antiviral proteins and a lack of cells that promote antivirus immune responses. A study found that people with EH had significantly earlier onset of eczema and significantly higher levels of the antibodies produced by their immune system to combat allergies.
Your doctor can likely diagnose EH by its appearance, but they may want to confirm the diagnosis. This is because EH can resemble some bacterial infections, like impetigo.
It also can look like a severe flare-up of eczema or other skin issues. Your doctor will probably have you take systemic antiviral drugs immediately if they think you have EH. An EH diagnosis can be confirmed by taking a smear of a blister to check for the virus. Several tests are available to identify the virus, including culturing the sample, identifying antibodies to the virus, or examining it under a light microscope. If left untreated — or not treated soon enough — EH can lead to blindness though this is rare and other complications.
In patients with severe or poorly-controlled atopic dermatitis, the characteristic morphology may be difficult to recognize and can be misdiagnosed as an exacerbation of eczematous dermatitis. The diagnosis of eczema herpeticum can be made clinically if characteristic morphology is present.
Viral polymerase chain reaction PCR can be performed on vesicle fluid to confirm the diagnosis and determine the type of herpesvirus with high sensitivity and specificity. Bacterial culture should be done if there is a concern for impetiginization. If the clinical presentation is atypical, a skin biopsy may be indicated.
Laboratory tests may reveal lymphopenia and an increased erythrocyte sedimentation rate. Eczema herpeticum patients should be treated promptly with systemic acyclovir or valacyclovir to minimize the risk of complications and prevent progression to severe disease. The differential diagnosis for eczema herpeticum includes impetigo, hand-foot-and-mouth disease, eczema coxsackium, primary varicella infection, disseminated herpes zoster, disseminated molluscum contagiosum, acute generalized exanthematous pustulosis, dermatitis herpetiformis, cellulitis, and erysipelas.
Misdiagnosis of EH can lead to delayed initiation of antiviral treatment and subsequent complications. Diagnostic clues that favor EH are painful lesions, monomorphic size of the lesions, and characteristic "punched-out" erosions in areas of pre-existing atopic dermatitis.
Unlike herpes zoster, EH does not respect dermatomal boundaries. Eczema herpeticum is a potentially life-threatening disease with mortality risk due to complications of systemic viremia, bacteremia, and fungal infection leading to multi-organ failure. A study of hospitalized pediatric EH patients in the United States found no deaths and concluded that the mortality rate of hospitalized patients is low.
The median length of hospital stay was three days, with 9. Only 4. Potential complications of EH include cutaneous superinfection with Staphylococcus aureus S. Patients with eczema herpeticum should be counseled that they are infectious until all lesions have crusted over and thus avoid close contact with others until then. Encourage patients to avoid scratching and wash hands frequently due to the risk of autoinoculation.
Patients diagnosed with mild EH and treated as outpatients should be cautioned to seek emergency care if they develop systemic symptoms or worsening rash, as they may require hospitalization, intravenous acyclovir treatment, or antibiotic coverage.
Eczema herpeticum is considered a medical emergency and should be treated promptly with systemic antivirals, as misdiagnosis and delay in treatment can result in serious complications. An ophthalmologic evaluation is warranted in cases of EH involving the face and eyelids. A dermatology consult may be beneficial to confirm the diagnosis. Clinicians should be aware of the risk factors associated with EH, including severe or poorly controlled atopic dermatitis, food and environmental allergies, asthma, the onset of atopic dermatitis before age five, and history of S.
Patients with systemic symptoms or widespread involvement should be promptly referred to the Emergency Department. To improve patient outcomes and prevent morbidity and mortality, healthcare providers should have a high index of suspicion for EH in patients with a history of atopic dermatitis presenting with a sudden onset, vesicular, monomorphic rash in areas of pre-existing dermatitis.
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StatPearls [Internet]. Search term. Affiliations 1 Western University. Continuing Education Activity Eczema herpeticum EH is a disseminated cutaneous infection with herpes simplex virus that develops in a patient with atopic dermatitis. Introduction Eczema herpeticum EH is a disseminated cutaneous infection with herpes simplex virus that develops in a patient with atopic dermatitis. Etiology Eczema herpeticum is due to cutaneous superinfection with herpes simplex virus HSV , usually HSV-1, in patients with atopic dermatitis.
Multiple chronic eczematous lesions with erosions and excoriations were noted over the frontal region and the cheeks. She was taken to a local clinic, where impetigo and acute upper respiratory tract infection were initially considered. A topical antibiotic ointment and other medications were prescribed to relieve the symptoms, but the fever persisted. Two days later, she experienced general malaise, poor activity, periorbital swelling, and purulent discharge from the cutaneous lesions; therefore, she was brought to our pediatric outpatient department for evaluation.
She had received vaccination as scheduled but had not received vaccination in the past 6 months. On initial examination, the patient had a fever, with a temperature of Multiple grouped punched-out ulcers were noted with local dissemination over the frontal, periorbital, and perioral areas and cheeks Figure 1. Furthermore, secondary impetiginization was observed around the mouth. However, no palpable lymphadenopathy was found.
Multiple grouping punched-out ulcers with local dissemination over the frontal, periorbital and perioral areas and cheeks, with secondary impetiginization. A dermatologist consultant diagnosed eczema herpeticum with secondary impetiginization, which was confirmed by a Tzanck test for multinucleated giant cells Figure 2 and virus isolation HSV The patient was prescribed systemic acyclovir.
An ophthalmologist diagnosed nonspecific conjunctivitis without herpetic keratitis. Tzanck smear from scraping of vesicle base of patient, showing multinucleated giant cells.
Herpes simplex virus, a member of the double-stranded DNA Herpesviridae family, can infect the epidermis owing to impaired skin protective function such as in AD. Eczema herpeticum is a secondary viral infection usually caused by HSV either type 1 or type 2 that concomitantly occurs with skin conditions like AD, psoriasis, eczema, irritant contact dermatitis, burns, and seborrheic dermatitis.
Initially, the involved skin might show erythematous changes presenting as small, monomorphic, dome-shaped papulovesicles that rupture to form tiny punched-out ulcers overlying an erythematous base. Patients often present with herpetic vesicles over an extensive mucocutaneous surface, most often the face, neck, and upper trunk.
Patients might have accompanying symptoms like fever, malaise, and lymphadenopathy. The virus is presumably spread from a recurrent oral HSV infection or asymptomatic shedding from the oral mucosa. Just like other HSV infections, eczema herpeticum can recur. Patients might present with localized HSV infection in previously involved areas.
Secondary bacterial infection, mostly due to S aureus , often occurs because of the inflammatory and extensive nature of the process. Early diagnosis of eczema herpeticum can prevent or minimize complications. The criterion standard for diagnosis of HSV infection is virus culture. In our case, the final virus isolation confirmed our diagnosis. The quality of the swab and culture techniques affect the specificity and sensitivity of virus culture. The microscopic finding of a Tzanck test for multinucleated giant cells can confirm a herpes virus infection and provide rapid diagnosis.
Although it is a very easy and quick bedside test, its specificity and sensitivity depend on the operator. Many people get HSV-1 through nonsexual contact, including kissing or sharing personal items, such as lip balm or utensils. HSV-2 spreads through sexual contact with a person who has the infection. It can cause blisters in the genital area, known as genital herpes. It can also pass from a woman to a baby during childbirth if the woman has the infection.
Once a person has one of these viruses, it will stay in their body for life. A person with herpes is more likely to spread it to others when blisters are present. However, herpes can still spread to another person when there are no symptoms.
Antiviral medications cannot cure a person of the herpes infection, but they can reduce the frequency and severity of herpes outbreaks. They can also reduce the chances of it spreading from person to person, but they cannot eliminate the risk. A doctor can usually recognize eczema herpeticum by looking at the symptoms. However, it can sometimes be difficult to distinguish the condition from an eczema flare. To confirm a diagnosis, the doctor may take a swab from a blister to check for bacteria or a virus.
Although a virus causes herpes, if the area becomes exposed to bacteria, a bacterial infection can also be present. When this occurs, it is called a secondary infection. To treat eczema herpeticum, a doctor will likely prescribe an antiviral medication, usually in the form of tablets or syrup.
They will often also recommend continuing any ongoing eczema treatment. The person may also need to take antibiotics if a secondary infection develops. If symptoms worsen quickly, the person may need urgent medical treatment. If there are signs of infection in the eye, they will need to see an ophthalmologist, often urgently, as herpes in the eye can lead to blindness.
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