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Eczema Herpeticum

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Eczema Herpeticum

  1. 1. Eczema HerpeticumEczema Herpeticum Sarah GoodallSarah Goodall
  2. 2. ObjectivesObjectives  IntroductionIntroduction  AetiologyAetiology  Clinical PresentationClinical Presentation  DiagnosisDiagnosis  TreatmentTreatment  ConclusionConclusion
  3. 3. IntroductionIntroduction  Described by Kaposi in 1887Described by Kaposi in 1887  Herpetic super-infection of pre-existingHerpetic super-infection of pre-existing skin diseaseskin disease  HSV-1 or HSV-2HSV-1 or HSV-2  Potentially life-threateningPotentially life-threatening
  4. 4. Eczema HerpeticumEczema Herpeticum
  5. 5. AetiologyAetiology 1.1. Auto-inoculationAuto-inoculation 2.2. Infectious contactInfectious contact  Disruption of stratum corneumDisruption of stratum corneum  Recent trauma (e.g. burns)Recent trauma (e.g. burns)  Auto-grafted skinAuto-grafted skin  Post dermabrasionPost dermabrasion } Disruption of integrity of the epidermis
  6. 6.  Immunosuppression – (medication)Immunosuppression – (medication)  Precipitating factors of HSVPrecipitating factors of HSV Reports of Eczema Herpeticum:Reports of Eczema Herpeticum: Atopic dermatitisAtopic dermatitis Pemphigus vulgarisPemphigus vulgaris Seborrheic dermatitisSeborrheic dermatitis Wiskott Aldrich syndromeWiskott Aldrich syndrome Etc….Etc….
  7. 7. Clinical PresentationClinical Presentation  Multiple clusters of vesiclesMultiple clusters of vesicles  Vesicles spread Haemorrhagic &Vesicles spread Haemorrhagic & crustedcrusted  Painful punched out erosionsPainful punched out erosions  FeverFever  Malaise/systemically unwellMalaise/systemically unwell
  8. 8. Differential DiagnosisDifferential Diagnosis  Exacerbation of primary skin lesionExacerbation of primary skin lesion  Animal Pox VirusAnimal Pox Virus  Blistering diseaseBlistering disease -e.g. pemphigus vulgaris-e.g. pemphigus vulgaris - bullous pemphigoid- bullous pemphigoid
  9. 9. DiagnosisDiagnosis  Punched out erosionsPunched out erosions  Fever and extreme painFever and extreme pain  Tzanck preparationTzanck preparation  Direct fluorescent antibodyDirect fluorescent antibody  Viral cultureViral culture
  10. 10. TreatmentTreatment  Acyclovir – IV 15mg/kg/day (5-10 days)Acyclovir – IV 15mg/kg/day (5-10 days) Oral 400mg 5x day 5-10 daysOral 400mg 5x day 5-10 days  PainPain  Bacterial super-infectionBacterial super-infection  ProphylaxisProphylaxis
  11. 11. Why is it a dermatologicalWhy is it a dermatological Emergency?Emergency?  Life threatening!Life threatening!  Herpes keratitisHerpes keratitis
  12. 12. Herpes keratitisHerpes keratitis  Western world - commonest cause ofWestern world - commonest cause of corneal blindnesscorneal blindness  Pain, photophobia, blurred vision, tears,Pain, photophobia, blurred vision, tears, rednessredness  Infectious – corneal vesicles, dendriticInfectious – corneal vesicles, dendritic ulcers, geographical ulcersulcers, geographical ulcers  Consider corneal transplantConsider corneal transplant
  13. 13. ConclusionConclusion  Herpetic super-infection of pre-existing skinHerpetic super-infection of pre-existing skin diseasedisease  Potentially life-threateningPotentially life-threatening  Early recognition vitalEarly recognition vital  Effective treatmentEffective treatment
  14. 14. Pre-existing skin diseasePre-existing skin disease andand Acute Blistering?Acute Blistering? ThinkThink Eczema HerpeticumEczema Herpeticum
  15. 15. ReferencesReferences  Mackley C, Adams DR, Anderson B, Miller JJ. Eczema herpeticum: aMackley C, Adams DR, Anderson B, Miller JJ. Eczema herpeticum: a dermatological emergencydermatological emergency Dermatology NursingDermatology Nursing Oct 2002;14(5):307-10Oct 2002;14(5):307-10  Wollenberg A, Zoch C et al. Predisposing factors and clinical features ofWollenberg A, Zoch C et al. Predisposing factors and clinical features of eczema herpeticum: a retrospective analysis of 100 caseseczema herpeticum: a retrospective analysis of 100 cases Journal of theJournal of the American Academy of DermatologyAmerican Academy of Dermatology Aug 2003;49(2):198-205Aug 2003;49(2):198-205  Buccolo LS. Severe rash after dermatitisBuccolo LS. Severe rash after dermatitis The Journal of Family PracticeThe Journal of Family Practice Aug 2004;53(8):Aug 2004;53(8):  Atherton DJ, Marshall WC. Eczema herpeticum.Atherton DJ, Marshall WC. Eczema herpeticum. PractitionerPractitioner 1982;226:971–973.1982;226:971–973.  Simon C, Everitt H, Kendrick T.Simon C, Everitt H, Kendrick T. Oxford Handbook of General PracticeOxford Handbook of General Practice 2nd ed. Oxford: Oxford University Press, 20052nd ed. Oxford: Oxford University Press, 2005

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