Overview of Eczema Herpeticum

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Eczema herpeticum (EH) is a serious and painful skin infection, which results in a rash and blistering on various parts of the body. EH is also known as Kaposi varicelliform eruption because it bears some resemblance to chicken pox, which is caused by the varicella-zoster virus. On the other hand, EH is typically caused by the herpes simplex 1 virus (HSV-1), the same virus that is responsible for cold sores in and around the mouth. This might bring to mind the term “oral herpes.”

The viral infection that can cause cold sores may develop in other areas of the body as well—in some cases, the condition can be life-threatening.

Additionally, the strain of herpes that is responsible for genital herpes, known as herpes simplex 2 virus (HSV-2), may be connected to EH infections. 

People who are most prone to EH are young children and individuals with inflammatory skin disorders like atopic dermatitis (AD), which often shows up as an itchy, red rash.

Symptoms

In addition to the potential for a widespread outbreak of uncomfortable blisters and rashes, EH often occurs with an onslaught of systemic symptoms as well, according to a report in Der Hautarzt, an international dermatology journal. It is unknown why some people with inflammatory skin disorders repeatedly develop EH and others do not.

What generally happens first is that crimson-colored, fluid-filled blisters appear on the face and neck, followed by other areas of the body. After the initial exposure to the herpes simplex virus, signs and symptoms commonly show up within two weeks:

  • Collection of itchy, painful blisters and ulcers
  • Skin lesions that may display a “punched out” appearance
  • Blisters that are red, purple, or black in color
  • Pus that may seep from broken blisters (they may bleed)
  • Skin eruptions that might crust over
  • Fever and chills
  • Enlarged lymph nodes
  • Feelings of weakness or overall malaise
  • Blisters that may lead to scarring

If you suspect you or your child has symptoms of EH, seek out medical care as soon as possible. Since the viral infection can disseminate throughout the body, knowing the symptoms can help you get prompt medical attention.

Causes

As mentioned, EH is caused by an infection from the herpes simplex virus. This virus can be transmitted from one person to another by skin-to-skin contact, as stated by the American Academy of Dermatology.

It may be surprising to learn that touching a sore or skin lesion of an infected person is only one way to contract the infection. Another way is through a phenomenon known as asymptomatic viral shedding—a person may be infected and not have any sores or additional symptoms. From time to time, however, the virus can become reactivated in people who carry it.

Although there may be no apparent signs or symptoms, the virus can be “shed” or transmitted to another individual during the period of reactivation.

Additionally, people who have abnormalities in the protective barrier of the skin, such as those with AD, are more likely to contract EH. Normally, the skin’s barrier helps to keep it moisturized while guarding against environmental factors like bacteria and viruses. When the barrier is compromised, skin can become, dry, cracked, and sensitive, leaving people more susceptible to infections. 

Diagnosis

A prompt diagnosis of EH is critical to have the best chance of a successful recovery and minimize the risk of complications.

A healthcare provider can diagnose EH based on clinical presentation, but the infection can look similar to impetigo, chicken pox, and complications from the smallpox vaccine in people with AD.

To confirm the viral infection, a swab may be taken and cultured from one of the blisters or lesions. The doctor may also order a culture to check for the presence of bacteria, which is known as a secondary infection and can be a common occurrence among EH cases. Therefore, it is possible to have both a bacterial and a viral infection simultaneously. Generally, you will not need to have imaging (such as an X-ray or MRI) performed to diagnosis EH.

Treatment

The primary way to treat EH is with acyclovir, an antiviral medication. Oral use of the drug can be used in children under the age of 18. If a person has a severe case of EH or is significantly immunocompromised, their physician or medical team may recommend treatment in the hospital where systemic medications, such as intravenous or injections, can be administered.

If a secondary infection is suspected, you may be prescribed antibiotics at the same time. Additionally, if EH is near the eyes, a consultation with an ophthalmologist is advised—the herpes simplex virus can affect the eyes and cause scarring of the cornea.

Prevention

Can EH be prevented? To stop the spread of the virus from one person to another, the National Eczema Association (NEA) recommends the following tips:

  • If you have AD or another inflammatory skin condition, avoid contact with people who have cold sores.
  • Don’t share personal items like lipstick, silverware, or cups with people who have the herpes simplex virus.

Additional preventive measures include:

  • Try your best to keep AD and other skin disorders under control.
  • Minimize your eczema triggers.
  • To protect your skin, moisturize after bathing or showering.
  • Take your medications as prescribed by your healthcare provider.
  • If you experience an unexplained flare-up of eczema symptoms, see your physician.
  • Wash your hands to reduce the risk of catching or spreading infection.
  • Ask potential sexual partners if they have a history of genital herpes. If they do, refrain from sexual contact with them.
  • To minimize your risk of acquiring the herpes virus during sex, use a condom to protect yourself from sexually transmitted infections (STIs).

A Word From Verywell

If you have an unexplained red, blistery rash accompanied by a fever (especially if you have a history of atopic dermatitis or another skin condition) see your doctor as soon as possible. The quicker you can get a proper diagnosis and begin treatment, the better your chances are of having a successful recovery and reducing possible complications.

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Article Sources
  • American Academy of Dermatology. Herpes simplex.

  • British Association of Dermatologists. Eczema Heperticum.

  • National Eczema Association. Eczema Heperticum.

  • Rerinck HC, Kamann S, Wollenberg A. Eczema herpeticatum. Pathogenese und Therapie. 2006 July; 57(7): 586-591. DOI: 10.1007/s00105-006-1168-x

  • Liaw FY, Huang CF, Hsueh JT, Chiang CP. Eczema herpeticum. Canadian Family Physician. 2012 Dec; 58(12): 1358–1361

  • Rerinck HC, Kamann S, Wollenberg A. Eczema herpeticatum. Der Hautarzt. 2006;57(7):586-591. DOI: 10.1007/s00105-006-1168-x