What is the recommended treatment for Eczema Herpeticum in a 10-year-old male (YOM) weighing 32.7 kilograms (kg)?

Treatment of Eczema Herpeticum in a 10-Year-Old Male Weighing 32.7 kg

Systemic acyclovir therapy is the treatment of choice for eczema herpeticum in this 10-year-old patient. 1

First-Line Treatment

1. Systemic Antiviral Therapy

   • Intravenous acyclovir is recommended for severe cases or those with systemic symptoms
   • Oral acyclovir can be used for milder cases
   • Dosing for this 32.7 kg child:
     • IV acyclovir: 250 mg/m² every 8 hours (or 5 mg/kg every 8 hours)
     • Oral acyclovir: 200 mg five times daily for five days 2

2. Management of Underlying Atopic Dermatitis

   • Continue appropriate skin care during treatment
   • Apply fragrance-free emollients multiple times daily, especially after bathing 3
   • Avoid systemic corticosteroids as they are associated with 18% longer hospital stays in children with eczema herpeticum 4

Topical Therapy Considerations

• Topical corticosteroids can be safely used during eczema herpeticum treatment

  • Research shows that topical corticosteroid use is not associated with longer hospital stays or worsened outcomes 4
  • Medium-potency corticosteroids are appropriate for this age group 3

• Antiseptic measures:

  • Aqueous chlorhexidine 0.05% can be used on erosive lesions 3
  • Bleach baths with 0.005% sodium hypochlorite twice weekly help prevent secondary bacterial infections 3

Clinical Monitoring and Follow-up

• Monitor for:
  • Resolution of vesicular and erosive lesions
  • Improvement of systemic symptoms (fever, malaise)
  • Signs of secondary bacterial infection
  • Complete recovery typically occurs without sequelae when properly treated 5

Important Clinical Pearls

• Eczema herpeticum only affects areas with active atopic dermatitis lesions; skin without AD lesions is never affected by herpetic lesions 6
• Early diagnosis is critical as eczema herpeticum is potentially life-threatening
• In approximately 28% of cases, eczema herpeticum is initially misdiagnosed as an exacerbation or impetiginization of underlying dermatitis 5
• Consider family history of herpes labialis, as one-third of affected children have a parent with recent herpes labialis 5
• Patients with extrinsic atopic dermatitis (allergic/IgE-mediated) are at higher risk for eczema herpeticum 6

Prevention of Recurrence

• Maintain good control of underlying atopic dermatitis
• Early onset of atopic dermatitis is a risk factor for recurrent eczema herpeticum 6
• Identify and eliminate triggering substances to prevent eczema flare-ups 3
• Consider air purifiers to reduce PM 2.5 exposure, especially during dry moderate weather conditions 3