What are the other Names for this Condition? (Also known as/Synonyms)

• Kaposi Varicelliform Eruption

What is Eczema Herpeticum? (Definition/Background Information)

• Eczema Herpeticum is a contagious viral infection that is caused by herpes simplex virus (HSV types 1 and 2). The infection mostly affects young children and infants, who have a skin condition called atopic dermatitis
• The risk factors for Eczema Herpeticum includes various skin conditions such as eczema, irritant seborrheic dermatitis, and severe burns. Also, individuals with poor immune systems have high risks for infection
• The signs and symptoms of Eczema Herpeticum include the presence of fluid-filled skin lesions that ulcerate. The affected area includes the head and neck region and body torso. The condition may be accompanied by fever, fatigue, and swollen lymph nodes
• It is important to diagnose and treat Eczema Herpeticum, in order to improve outcomes, especially in the immunocompromised. The treatment typically involves the administration of antiviral drugs and undertaking treatment for any underlying condition causing poor immunity
• The prognosis for Eczema Herpeticum is good in many cases. But, the outcome is also dependent upon the overall health status of the individual and severity of infection

Who gets Eczema Herpeticum? (Age and Sex Distribution)

• Eczema Herpeticum is an infectious disease that can be seen in individuals of any age category. However, it is more common in infants and children with atopic dermatitis
• Both males and females are affected and no gender preference is noted
• Individuals of all racial and ethnic backgrounds have the same risk for infection

What are the Risk Factors for Eczema Herpeticum? (Predisposing Factors)

The risk factors for Eczema Herpeticum include certain skin conditions such as the following:

• Atopic dermatitis
• Psoriasis
• Extensive burns
• Eczema
• Irritant seborrheic dermatitis
• Cutaneous T-cell lymphoma
• Pemphigus vulgaris
• Darier disease
• Individuals, who have poor immune system are at high risk for infection

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Eczema Herpeticum? (Etiology)

Eczema Herpeticum is a contagious viral infection that is caused by either of type 1 or type 2 herpes simplex virus (HSV type 1 or type 2). The condition is known to usually occur during the first episode of HSV infection. Eczema Herpeticum is described as an uncommon complication of HSV infection.

• It results in extensive fluid-filled skin (vesicular) eruptions. The condition is mostly seen against a background of atopic dermatitis
• These viruses are contagious and can spread easily on contact with an infected individual, especially if one has a weak immunity

What are the Signs and Symptoms of Eczema Herpeticum?

The signs and symptoms of Eczema Herpeticum may include:

• The presence of a skin red rash that leads to blister formation, which is followed by ulceration
• The skin lesions usually consist of fluid-filled vesicles with a red base (erythematous)
• These fluid-filled vesicles or blisters can burst causing skin ulcers
• The blisters are painful and/or itchy
• Formation of the skin sores usually start in areas where there is eczema
• The head and neck region and upper trunk are affected the most, although the lesions may be present inside the mouth (affecting the oral mucosa)
• Certain associated signs and symptoms, such as fatigue, fever, and enlarged lymph nodes, may be seen
• In some individuals, the condition can be chronic and recurrent (it can come and go over time)

How is Eczema Herpeticum Diagnosed?

The diagnosis of Eczema Herpeticum may involve the following tests and exams:

• A complete physical examination and analysis of past medical history by a healthcare provider
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Viral culture: A culture may be performed to confirm the presence of virus and to rule-out other causes of infection. In this culture, a small amount of pus or fluid from one of the sores is collected and sent to the lab for testing. The test results can help confirm the presence and type of virus (if any present)
• Molecular test on the fluid in the vesicles (via PCR), to detect herpes virus
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis
• Differential diagnosis of the following skin conditions presenting similar symptoms should be ruled out:
  • Impetigo
  • Primary varicella infection

 Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Eczema Herpeticum?

The complications of Eczema Herpeticum may include:

• Skin disfigurement due to the presence of widespread lesions. This can lead to cosmetic concerns and increased emotional stress
• Scarring on healing of skin lesions may be observed
• Bacterial superimposed infections over the skin lesions; this secondary bacterial infection can result in septicemia
• Eye infection resulting in herpetic keratitis, leading to blindness
• Decreased or increased skin color (hypopigmentation or hyperpigmentation respectively) following healing of the condition

Eczema Herpeticum can result in severe infection spreading extensively, which may even lead to death.

How is Eczema Herpeticum Treated?

Eczema Herpeticum is considered to be a medical emergency. An early diagnosis and treatment is crucial and important for positive outcomes. The following treatment options may be considered:

• Administration of anti-viral medications
• Topical skin ointments and creams
• Treating any underlying immunocompromised state (if present)
• Antibiotic medication for any secondary bacterial infections

How can Eczema Herpeticum be Prevented?

In general, it may not be possible to prevent Eczema Herpeticum; however, the following measures may be considered:

• Preventing the triggers for underlying risk factors, such as eczema and atopic dermatitis
• Undertaking appropriate and adequate treatment of any underlying condition (that may be a risk factor for Eczema Herpeticum), as instructed by the healthcare provider
• Practicing good and regular hand washing techniques, to prevent spread of the virus
• Avoiding individuals, who have cold sores or other such infections
• Covering one’s mouth during coughing or sneezing
• Avoid exposure to or direct contact with individuals who are infected 

What is the Prognosis of Eczema Herpeticum? (Outcomes/Resolutions)

• Eczema Herpeticum has a good prognosis with early diagnosis and prompt treatment, in most cases. The skin lesions are known to heal within 2-6 weeks
• However, the prognosis in individuals with decreased immunity is mostly poor

Additional and Relevant Useful Information for Eczema Herpeticum:

• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for Eczema Herpeticum. However, it helps to be clean and hygienic, which will help the condition from getting worse