1. Eczema HerpeticumEczema Herpeticum
Sarah GoodallSarah Goodall

2. ObjectivesObjectives
 IntroductionIntroduction
 AetiologyAetiology
 Clinical PresentationClinical Presentation
 DiagnosisDiagnosis
 TreatmentTreatment
 ConclusionConclusion

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. Eczema HerpeticumEczema Herpeticum

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.  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. 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

9. 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

10. DiagnosisDiagnosis
 Punched out erosionsPunched out erosions
 Fever and extreme painFever and extreme pain
 Tzanck preparationTzanck preparation
 Direct fluorescent antibodyDirect fluorescent antibody
 Viral cultureViral culture

11. 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

12. Why is it a dermatologicalWhy is it a dermatological
Emergency?Emergency?
 Life threatening!Life threatening!
 Herpes keratitisHerpes keratitis

13. 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

14. 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

15. Pre-existing skin diseasePre-existing skin disease
andand
Acute Blistering?Acute Blistering?
ThinkThink
Eczema HerpeticumEczema Herpeticum

16. 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