Eczema Herpeticum

1. Eczema HerpeticumEczema Herpeticum
Sarah GoodallSarah Goodall

2. ObjectivesObjectives

IntroductionIntroduction

AetiologyAetiology

Clinical PresentationClinical Presentation

DiagnosisDiagnosis

TreatmentTreatment

ConclusionConclusion

3. IntroductionIntroduction

Described by Kaposi in 1887Described by Kaposi in 1887

Herpetic super-infection of pre-existing Herpetic super-infection of pre-existing
skin diseaseskin disease

HSV-1 or HSV-2HSV-1 or HSV-2

Potentially life-threateningPotentially life-threatening

4. Eczema HerpeticumEczema Herpeticum

5. AetiologyAetiology
1.1.Auto-inoculationAuto-inoculation
2.2.Infectious contactInfectious contact

Disruption of stratum corneumDisruption of stratum corneum

Recent trauma (e.g. burns)Recent trauma (e.g. burns)

Auto-grafted skinAuto-grafted skin

Post dermabrasionPost dermabrasion}
Disruption
of
integrity of
the
epidermis

6. 
Immunosuppression – (medication)Immunosuppression – (medication)

Precipitating factors of HSVPrecipitating factors of HSV
Reports of Eczema Herpeticum:Reports of Eczema Herpeticum:
Atopic dermatitisAtopic dermatitis
Pemphigus vulgarisPemphigus vulgaris
Seborrheic dermatitisSeborrheic dermatitis
Wiskott Aldrich syndrome Wiskott Aldrich syndrome
Etc….Etc….

7. Clinical PresentationClinical Presentation

Multiple clusters of vesiclesMultiple clusters of vesicles

Vesicles spread Haemorrhagic & Vesicles spread Haemorrhagic &
crustedcrusted

Painful punched out erosionsPainful punched out erosions

FeverFever

Malaise/systemically unwellMalaise/systemically unwell

9. Differential DiagnosisDifferential Diagnosis

Exacerbation of primary skin lesionExacerbation of primary skin lesion

Animal Pox VirusAnimal Pox Virus

Blistering diseaseBlistering disease
-e.g. pemphigus vulgaris-e.g. pemphigus vulgaris
- bullous pemphigoid- bullous pemphigoid

10. DiagnosisDiagnosis

Punched out erosions Punched out erosions

Fever and extreme painFever and extreme pain

Tzanck preparationTzanck preparation

Direct fluorescent antibody Direct fluorescent antibody

Viral cultureViral culture

11. TreatmentTreatment

Acyclovir – IV 15mg/kg/day (5-10 days)Acyclovir – IV 15mg/kg/day (5-10 days)
Oral 400mg 5x day 5-10 daysOral 400mg 5x day 5-10 days

PainPain

Bacterial super-infection Bacterial super-infection

ProphylaxisProphylaxis

12. Why is it a dermatologicalWhy is it a dermatological
Emergency?Emergency?

Life threatening!Life threatening!

Herpes keratitisHerpes keratitis

13. Herpes keratitisHerpes keratitis

Western world - commonest cause of Western world - commonest cause of
corneal blindnesscorneal blindness

Pain, photophobia, blurred vision, tears, Pain, photophobia, blurred vision, tears,
rednessredness

Infectious – corneal vesicles, dendritic Infectious – corneal vesicles, dendritic
ulcers, geographical ulcersulcers, geographical ulcers

Consider corneal transplantConsider corneal transplant

14. ConclusionConclusion

Herpetic super-infection of pre-existing skin Herpetic super-infection of pre-existing skin
diseasedisease

Potentially life-threateningPotentially life-threatening

Early recognition vitalEarly recognition vital

Effective treatmentEffective treatment

15. Pre-existing skin diseasePre-existing skin disease
and and
Acute Blistering?Acute Blistering?
ThinkThink
Eczema HerpeticumEczema Herpeticum

16. ReferencesReferences

Mackley C, Adams DR, Anderson B, Miller JJ. Eczema herpeticum: a Mackley C, Adams DR, Anderson B, Miller JJ. Eczema herpeticum: a
dermatological emergency dermatological emergency Dermatology NursingDermatology Nursing Oct 2002;14(5):307-10 Oct 2002;14(5):307-10

Wollenberg A, Zoch C et al. Predisposing factors and clinical features of Wollenberg A, Zoch C et al. Predisposing factors and clinical features of
eczema herpeticum: a retrospective analysis of 100 cases eczema herpeticum: a retrospective analysis of 100 cases Journal of the Journal of the
American Academy of Dermatology American Academy of Dermatology Aug 2003;49(2):198-205Aug 2003;49(2):198-205

Buccolo LS. Severe rash after dermatitis Buccolo LS. Severe rash after dermatitis The Journal of Family Practice The Journal of Family Practice
Aug 2004;53(8):Aug 2004;53(8):

Atherton DJ, Marshall WC. Eczema herpeticum. Atherton DJ, Marshall WC. Eczema herpeticum. PractitionerPractitioner
1982;226:971–973.1982;226:971–973.

Simon C, Everitt H, Kendrick T. Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice Oxford Handbook of General Practice
2nd ed. Oxford: Oxford University Press, 2005 2nd ed. Oxford: Oxford University Press, 2005