​Dermatology - Eczema Herpeticum

​Dermatology - Eczema Herpeticum 
Eczema Herpeticum is a skin condition caused by the herpes simplex virus. 

Eczema herpeticum is a condition when the herpes simplex virus affects the skin affected by atopic dermatitis. Additional dermatological conditions susceptible to herpes infection encompass Darier disease, thermal burns, Hailey-Hailey disease, immunobullous disease, ichthyosis vulgaris, and cutaneous T cell lymphoma.

Primary eczema herpeticum can be accompanied by symptoms such as fever, malaise, and irritability. Recurrent cases are characterized by a previous occurrence of identical lesions, and the accompanying systemic symptoms are less intense.
The formation of lesions initiates in atypical skin and can spread outwardly over a span of many weeks in both first or recurring infections. Staphylococcus aureus is frequently seen as a secondary infection, which can cause significant discomfort.


Vesicles progress into erosions with a "punched-out" appearance and are scattered rather than clustered within the skin condition. Erosions have the potential to merge together, resulting in extensive areas without skin, and subsequent waves of fresh blister formation may arise.


The diagnosis is made based on clinical examination and verified through the use of a Tzanck smear, which identifies multinucleated acantholytic giant cells. Additionally, the presence of herpes simplex virus can be detected through culture or antigen detection methods. Exclude subsequent infections. The differential diagnosis include varicella, disseminated varicella infection, and disseminated (systemic) herpes simplex infection.


Untreated primary episodes often resolve within a period of 2-6 weeks.
Recurrent bouts are typically less severe and do not have any accompanying systemic symptoms. Maintaining cleanliness and ensuring the lesions remain dry during the natural healing process may be sufficient.
Treatment with oral acyclovir (200 mg orally 5 times per day or 400 mg three times a day) plus valacyclovir (1,000 mg orally twice per day or via IV 10–15 mg/kg three times per day) is recommended for infections that are expected to be long-lasting, severely symptomatic, or complicated, for a duration of 14–21 days.