From the Guidelines
Eczema herpeticum is a serious condition that requires prompt treatment with antiviral agents, such as acyclovir, and should be managed by a dermatologist or other qualified healthcare professional. Eczema, also known as atopic dermatitis, is a common inflammatory skin condition that can increase the risk of secondary infections, including eczema herpeticum, which is caused by the herpes simplex virus. According to the most recent guidelines, treatment of eczema typically involves a combination of moisturizers, topical corticosteroids, and avoidance of triggers such as harsh soaps and extreme temperatures 1. For severe cases, stronger prescription steroids or non-steroidal alternatives like tacrolimus or pimecrolimus may be needed. Daily moisturizing with fragrance-free products like CeraVe or Vanicream is essential, applied within 3 minutes after bathing to lock in moisture. Antihistamines like diphenhydramine can help with itching. If symptoms persist despite these measures, consultation with a dermatologist for advanced treatments like phototherapy or systemic medications is recommended. In cases of eczema herpeticum, systemic antiviral agents should be used, as recommended by guidelines from 2014 1.
Some key points to consider in the management of eczema and prevention of eczema herpeticum include:
- Avoiding triggers and irritants
- Keeping the skin moisturized
- Using topical corticosteroids as directed
- Avoiding excessive use of antibiotics, which can increase the risk of resistance and other complications 1
- Seeking prompt medical attention if symptoms of eczema herpeticum occur, such as increased redness, swelling, or pus-filled blisters.
It's also important to note that the term "herpeticum" refers to a specific complication of eczema, and not a type of eczema itself, as clarified by studies from 1995 1. Therefore, the most appropriate course of action for eczema herpeticum is to seek medical attention and follow the recommended treatment guidelines.
From the Research
Definition and Characteristics of Eczema Herpeticum
- Eczema herpeticum is a rare, severe, and disseminated infection of herpes simplex virus in the setting of eczematous skin diseases 2.
- It is characterized by a sudden onset of monomorphic vesicles, fever, and rapid progression 2, 3.
- The condition can occur in individuals with compromised skin barriers, such as those with atopic dermatitis (AD) 3.
Diagnosis and Differential Diagnosis
- The diagnosis of eczema herpeticum is made according to clinical features and confirmed by the findings of herpes simplex virus type 2 2.
- Differential diagnosis includes chickenpox, impetigo, eczema vaccinatum, and contact dermatitis 3.
- A positive IgM anti-HSV-1 serology, combined with clinical presentation, can support the diagnosis of eczema herpeticum in the absence of confirmatory tests 3.
Treatment and Management
- Oral valacyclovir may be an effective and convenient treatment option for pediatric outpatients with eczema herpeticum 2.
- Acyclovir is a highly potent and low-toxic antiviral agent that has been used to treat eczema herpeticum successfully 4.
- Intravenous aciclovir can result in significant improvement within 48 hours 3.
- Timely intervention with antiviral therapy is essential to prevent fatal outcomes 4, 5.