Eczema herpeticum: Difference between revisions
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==Background== | ==Background== | ||
*Diffuse [[HSV]] infection occurring in 3% of patients patients with [[atopic dermatitis]]<ref>Leung DYM. Why is eczema herpeticum unexpectedly rare? Antiviral research. 2013;98(2):153-157. doi:10.1016/j.antiviral.2013.02.010.</ref> | |||
*May be life-threatening | *May be life-threatening | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:Eczema Herpeticum picture.png|thumb|Eczema Herpeticum in immunocompromised patient.<ref>Bagazgoitia L, Beà S, Garate M, Moreno R, Jaén P. ECZEMA HERPETICUM IN A PATIENT WITH TERMINAL RENAL FAILURE UNDER NARROW-BAND UVB THERAPY. Indian Journal of Dermatology. 2010;55(2):200-201. doi:10.4103/0019-5154.62744.</ref>).]] | |||
[[File: Eczema_Herpticum_picutre_2.jpg|thumb|Eczema herpticum in child.<ref>Leung DYM. Why is eczema herpeticum unexpectedly rare? Antiviral research. 2013;98(2):153-157. doi:10.1016/j.antiviral.2013.02.010.</ref>]] | |||
*Development of vesicular eruptions containing HSV 1 or 2 in areas of epidermis previously affected by atopic dermatitis | *Development of vesicular eruptions containing HSV 1 or 2 in areas of epidermis previously affected by atopic dermatitis | ||
*Lesions may appear similar to impetigo ( | *Lesions may appear similar to impetigo<ref>Liaw F-Y, Huang C-F, Hsueh J-T, Chiang C-P. Eczema herpeticum: A medical emergency. Canadian Family Physician. 2012;58(12):1358-1361.</ref> | ||
* | *[[Fever]] is common | ||
*Multiple organ systems can | *Multiple organ systems can become involved, resulting in [[lymphadenopathy]], [[keratoconjunctivitis]] (potentially sight-threatening),[[meningitis]], [[encephalitis]], etc <ref>Leung DYM. Why is eczema herpeticum unexpectedly rare? Antiviral research. 2013;98(2):153-157. doi:10.1016/j.antiviral.2013.02.010.</ref>. | ||
*Lesions may become secondarily infected by bacteria, mainly with staph aureus ( | *Lesions may become secondarily infected by bacteria, mainly with staph aureus<ref>Leung DYM. Why is eczema herpeticum unexpectedly rare? Antiviral research. 2013;98(2):153-157. doi:10.1016/j.antiviral.2013.02.010.</ref>. | ||
*The following is associated with increased susceptibility to Eczema Herpeticum<ref>Bagazgoitia L, Beà S, Garate M, Moreno R, Jaén P. ECZEMA HERPETICUM IN A PATIENT WITH TERMINAL RENAL FAILURE UNDER NARROW-BAND UVB THERAPY. Indian Journal of Dermatology. 2010;55(2):200-201. doi:10.4103/0019-5154.62744.</ref>: | |||
*The following is associated with increased susceptibility to Eczema Herpeticum (2): | |||
**Early age of onset of eczema | **Early age of onset of eczema | ||
**History of food allergies or asthma ( | **History of food allergies or asthma<ref>Leung DYM. Why is eczema herpeticum unexpectedly rare? Antiviral research. 2013;98(2):153-157. doi:10.1016/j.antiviral.2013.02.010.</ref> | ||
**Larger surface area of eczema | **Larger surface area of eczema | ||
**Eczema of the head/neck | **Eczema of the head/neck | ||
**Increased levels of IgE | **Increased levels of IgE | ||
==Differential Diagnosis== | |||
*[[Impetigo]] | |||
*Eczema Vaccinatum | |||
*Primary [[varicella]] infection | |||
{{HSV-1 DDX}} | {{HSV-1 DDX}} | ||
==Evaluation== | ==Evaluation<ref>Liaw F-Y, Huang C-F, Hsueh J-T, Chiang C-P. Eczema herpeticum: A medical emergency. Canadian Family Physician. 2012;58(12):1358-1361.</ref>== | ||
*Clinical | *Clinical | ||
*Viral culture from swabs of wounds | *Viral culture from swabs of wounds | ||
*Tzanck smears showing multi-nucleated giant cells | *Tzanck smears showing multi-nucleated giant cells | ||
*Direct Fluorescence antigen test for HSV | *Direct Fluorescence antigen test for HSV | ||
==Management== | ==Management== | ||
*Treatment to cover [[Staph]] and [[Strep]] | *Treatment to cover [[Staph]] and [[Strep]] | ||
*[[Bactrim]] 10mg/kg/d in 2 divided doses '''OR''' [[clindamycin]] 24mg/kg/d divided into 3 doses x10d | *[[Bactrim]] 10mg/kg/d in 2 divided doses '''OR''' [[clindamycin]] 24mg/kg/d divided into 3 doses x10d | ||
*[[Acyclovir]] 80mg/kg/d in 3 divided doses x10 | *[[Acyclovir]] 80mg/kg/d in 3 divided doses x10<ref>Aronson PL, Yan AC, Mittal MK, Mohamad Z, Shah SS. Delayed Acyclovir and Outcomes of Children Hospitalized With Eczema Herpeticum. Pediatrics. 2011;128(6):1161-1167. doi:10.1542/peds.2011-0948.</ref> | ||
==Disposition== | ==Disposition== | ||
==See Also== | ==See Also== | ||
*[[HSV]] | |||
==External Links== | ==External Links== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Dermatology]] | [[Category:Dermatology]] | ||
[[Category:ID]] | [[Category:ID]] | ||
Latest revision as of 21:53, 29 January 2025
Background
- Diffuse HSV infection occurring in 3% of patients patients with atopic dermatitis[1]
- May be life-threatening
Clinical Features
Eczema Herpeticum in immunocompromised patient.[2]).
Eczema herpticum in child.[3]
- Development of vesicular eruptions containing HSV 1 or 2 in areas of epidermis previously affected by atopic dermatitis
- Lesions may appear similar to impetigo[4]
- Fever is common
- Multiple organ systems can become involved, resulting in lymphadenopathy, keratoconjunctivitis (potentially sight-threatening),meningitis, encephalitis, etc [5].
- Lesions may become secondarily infected by bacteria, mainly with staph aureus[6].
- The following is associated with increased susceptibility to Eczema Herpeticum[7]:
- Early age of onset of eczema
- History of food allergies or asthma[8]
- Larger surface area of eczema
- Eczema of the head/neck
- Increased levels of IgE
Differential Diagnosis
Herpes Simplex Virus-1
- Eczema herpeticum
- Herpes gingivostomatitis
- Herpes keratitis
- Herpes labialis (cold sore)
- Herpes simplex encephalitis
- Herpetic whitlow
Evaluation[9]
- Clinical
- Viral culture from swabs of wounds
- Tzanck smears showing multi-nucleated giant cells
- Direct Fluorescence antigen test for HSV
Management
- Treatment to cover Staph and Strep
- Bactrim 10mg/kg/d in 2 divided doses OR clindamycin 24mg/kg/d divided into 3 doses x10d
- Acyclovir 80mg/kg/d in 3 divided doses x10[10]
Disposition
See Also
External Links
References
- ↑ Leung DYM. Why is eczema herpeticum unexpectedly rare? Antiviral research. 2013;98(2):153-157. doi:10.1016/j.antiviral.2013.02.010.
- ↑ Bagazgoitia L, Beà S, Garate M, Moreno R, Jaén P. ECZEMA HERPETICUM IN A PATIENT WITH TERMINAL RENAL FAILURE UNDER NARROW-BAND UVB THERAPY. Indian Journal of Dermatology. 2010;55(2):200-201. doi:10.4103/0019-5154.62744.
- ↑ Leung DYM. Why is eczema herpeticum unexpectedly rare? Antiviral research. 2013;98(2):153-157. doi:10.1016/j.antiviral.2013.02.010.
- ↑ Liaw F-Y, Huang C-F, Hsueh J-T, Chiang C-P. Eczema herpeticum: A medical emergency. Canadian Family Physician. 2012;58(12):1358-1361.
- ↑ Leung DYM. Why is eczema herpeticum unexpectedly rare? Antiviral research. 2013;98(2):153-157. doi:10.1016/j.antiviral.2013.02.010.
- ↑ Leung DYM. Why is eczema herpeticum unexpectedly rare? Antiviral research. 2013;98(2):153-157. doi:10.1016/j.antiviral.2013.02.010.
- ↑ Bagazgoitia L, Beà S, Garate M, Moreno R, Jaén P. ECZEMA HERPETICUM IN A PATIENT WITH TERMINAL RENAL FAILURE UNDER NARROW-BAND UVB THERAPY. Indian Journal of Dermatology. 2010;55(2):200-201. doi:10.4103/0019-5154.62744.
- ↑ Leung DYM. Why is eczema herpeticum unexpectedly rare? Antiviral research. 2013;98(2):153-157. doi:10.1016/j.antiviral.2013.02.010.
- ↑ Liaw F-Y, Huang C-F, Hsueh J-T, Chiang C-P. Eczema herpeticum: A medical emergency. Canadian Family Physician. 2012;58(12):1358-1361.
- ↑ Aronson PL, Yan AC, Mittal MK, Mohamad Z, Shah SS. Delayed Acyclovir and Outcomes of Children Hospitalized With Eczema Herpeticum. Pediatrics. 2011;128(6):1161-1167. doi:10.1542/peds.2011-0948.