From the Guidelines
Eczema herpeticum should be treated promptly with oral or intravenous antiviral medications, primarily acyclovir, as it has significantly altered the course of this once potentially fatal condition, reducing mortality rates to zero when treated appropriately 1. The treatment approach involves administering oral acyclovir at 200-400 mg five times daily for 7-10 days for mild to moderate cases.
- For severe cases, hospitalization and intravenous acyclovir at 5-10 mg/kg every 8 hours until clinical improvement occurs may be necessary.
- Alternative antivirals, such as valacyclovir (1 gram twice daily) or famciclovir (250 mg three times daily), can be considered due to their better bioavailability and less frequent dosing. The importance of early treatment initiation is highlighted by the fact that timing of acyclovir initiation is directly related to the length of hospital course, with earlier medication initiation decreasing length of stay 1. Supportive care measures, including pain management, keeping lesions clean, and avoiding scratching to prevent secondary bacterial infections, should also be implemented. Additionally, patients should temporarily discontinue immunosuppressive medications used for underlying eczema, such as topical steroids or calcineurin inhibitors, as these can worsen the viral infection. It is crucial to note that antiviral therapy works by inhibiting viral DNA synthesis, preventing herpes simplex virus replication, and once the acute infection resolves, patients should resume appropriate eczema management to prevent recurrence. As stated in the guidelines, the treatment of eczema herpeticum with systemic antiviral medications has significantly altered the course of this once potentially fatal condition, with no deaths occurring from eczema herpeticum when patients received systemic antiviral therapy 1.
From the Research
Treatment Options for Eczema Herpeticum
- The primary treatment for eczema herpeticum involves antiviral medications, such as valacyclovir 2 and acyclovir 3, 4, 5.
- Oral acyclovir has been shown to be effective in treating eczema herpeticum, with an efficacy rate of 81.3 percent in one study 3.
- Valacyclovir is also an effective treatment option, particularly for pediatric outpatients 2.
- In cases of severe disease or immunocompromised patients, hospitalization for systemic antivirals may be required 4.
- Prompt treatment with oral acyclovir should be initiated as soon as eczema herpeticum is suspected, as misdiagnosis can lead to severe complications 4.
Important Considerations
- Eczema herpeticum is considered a medical emergency, and the index of suspicion for this infection should be high among clinicians 4.
- Any patient with pre-existing skin disease and acute "blistering" should be examined to rule out eczema herpeticum 4.
- The clinical presentation of eczema herpeticum can be characteristic, but the eruption might be confused with other infections like impetigo and primary varicella infection 4.