From the Guidelines
Eczema herpeticum should be treated with systemic antiviral medications, such as acyclovir, as soon as possible to significantly alter the course of this potentially fatal condition and reduce mortality rates to nearly zero, as demonstrated by Aronson and colleagues in a retrospective chart review of 1,331 children 1. The treatment of eczema herpeticum with systemic antiviral medications has been shown to be highly effective in reducing the length of hospital stay and preventing deaths, with earlier initiation of medication resulting in better outcomes 1.
- Key points to consider in the treatment of eczema herpeticum include:
- Initiating oral antiviral medication, such as acyclovir 400mg five times daily for 7-10 days, or valacyclovir 1g twice daily for 7-10 days, as soon as possible
- Considering intravenous acyclovir 5-10mg/kg every 8 hours in severe cases, especially with extensive skin involvement, fever, or in immunocompromised patients
- Continuing eczema treatments as directed by a physician
- Maintaining good skin hygiene and avoiding scratching to prevent bacterial superinfection
- Avoiding skin-to-skin contact with others until lesions have crusted over to prevent the spread of the virus
- It is essential to note that prompt treatment is crucial in preventing serious complications, including keratoconjunctivitis, meningitis, or encephalitis, particularly in immunocompromised individuals, and that recurrences are possible, especially during times of stress, illness, or sun exposure.
- The use of systemic antiviral medications, such as acyclovir, has significantly improved the outcomes of patients with eczema herpeticum, reducing mortality rates from 10 to 50 percent to nearly zero, as demonstrated by Aronson and colleagues 1.
From the Research
Definition and Diagnosis of Eczema Herpeticum
- Eczema herpeticum (EH) is a serious viral complication caused by the herpes simplex virus (HSV) that occurs in individuals with compromised skin barriers, such as those with atopic dermatitis (AD) 2.
- The clinical presentation of EH includes vesicular lesions, fever, and rapid progression, and the differential diagnosis includes chickenpox, impetigo, eczema vaccinatum, and contact dermatitis 2.
- A diagnosis of EH can be suspected based on the clinical presentation, and confirmed by direct fluorescent antibody test or IgM anti-HSV-1 serology 3, 2.
Treatment and Management of Eczema Herpeticum
- Acyclovir is the gold standard for treating EH, and timely intervention is essential to prevent severe complications, including bacteremia and death 3, 4, 5.
- Oral acyclovir can be effective in treating EH, with a reported efficacy rate of 81.3% in one study 5.
- In cases of severe disease or immunocompromised patients, hospitalization for systemic antivirals may be required 3.
- Early recognition and treatment of EH are crucial to prevent serious sequelae and improve patient outcomes 6, 2.
Clinical Insights and Pathogenesis Hypotheses
- EH can arise in various dermatological conditions, necessitating prompt recognition and management by healthcare providers 2.
- Understanding the epidemiology and pathogenesis of EH, especially in relation to AD, is crucial for effective management 2.
- A novel hypothesis linking structural protein alterations to immune dysfunction in EH has been proposed, suggesting a need for further research 2.