Summary about Disease
Eczema herpeticum (EH) is a rare but serious skin infection caused by the herpes simplex virus (HSV), usually type 1 (HSV-1), but sometimes type 2 (HSV-2). It occurs in individuals who have pre-existing skin conditions, most commonly atopic dermatitis (eczema), but also other conditions that disrupt the skin barrier. EH is characterized by a widespread, painful rash of small, fluid-filled blisters (vesicles) that can quickly spread across the body. It can be life-threatening, particularly in infants and young children, due to potential systemic complications.
Symptoms
Rapid onset of painful, itchy clusters of small blisters (vesicles)
Blisters often appear "punched out" or eroded, and may bleed or crust over.
Widespread distribution of lesions, commonly affecting areas already affected by eczema.
Fever
Fatigue, malaise
Swollen lymph nodes
Eye involvement (keratitis) can occur
In severe cases, systemic symptoms like high fever, dehydration, and seizures can occur.
Causes
Eczema herpeticum is primarily caused by:
Herpes Simplex Virus (HSV): Usually HSV-1 (oral herpes) but sometimes HSV-2 (genital herpes).
Pre-existing Skin Conditions: Atopic dermatitis (eczema) is the most common predisposing factor. Other skin conditions include:
Burns
Darier's disease
Ichthyosis
Wiskott-Aldrich syndrome
Compromised Skin Barrier: The weakened skin barrier in these conditions makes the skin more susceptible to HSV infection.
Autoinoculation: Spread of the virus to other areas of the body via scratching.
Medicine Used
The primary treatment for eczema herpeticum is antiviral medication. Common medications used include:
Oral Antivirals:
Acyclovir
Valacyclovir
Famciclovir
Intravenous Antivirals: In severe cases, particularly in hospitalized patients, intravenous acyclovir is used.
Topical Antibiotics: May be used to prevent or treat secondary bacterial infections.
Pain Management: Over-the-counter or prescription pain relievers may be used to manage pain.
Is Communicable
Yes, eczema herpeticum is highly contagious. The virus can be spread through:
Direct Contact: Skin-to-skin contact with the lesions.
Autoinoculation: Spreading the virus to other parts of the body by touching or scratching the lesions.
Indirect Contact: Touching contaminated objects (towels, clothing, etc.).
Precautions
Avoid Contact: Prevent contact with individuals who have active herpes infections (cold sores, genital herpes).
Good Hygiene: Frequent handwashing with soap and water.
Avoid Sharing: Do not share personal items such as towels, clothing, or razors.
Cover Lesions: Keep lesions covered with bandages to prevent spreading the virus.
Avoid Scratching: Minimize scratching to prevent autoinoculation and secondary infections.
Isolation: In severe cases, hospitalization and isolation may be necessary to prevent spread within a healthcare setting.
Awareness: Educate family members and caregivers about the contagious nature of the infection and the importance of taking precautions.
How long does an outbreak last?
With prompt antiviral treatment, an outbreak of eczema herpeticum typically lasts for 2 to 6 weeks. Without treatment, it can last longer and lead to more serious complications. The blisters will eventually crust over and heal.
How is it diagnosed?
Eczema herpeticum is typically diagnosed based on:
Clinical Examination: The characteristic appearance of the rash in a person with eczema or other pre-existing skin condition.
Tzanck Smear: A scraping from a blister examined under a microscope to look for characteristic viral changes in cells.
Viral Culture: A sample from the lesion is cultured to identify the herpes simplex virus.
Polymerase Chain Reaction (PCR): PCR testing can detect the presence of HSV DNA in a sample from the lesion. This is often the most sensitive and specific test.
Direct Fluorescent Antibody (DFA) Testing: A rapid test to detect HSV antigens in a sample from the lesion.
Skin Biopsy: In some cases, a skin biopsy may be performed to confirm the diagnosis.
Timeline of Symptoms
Initial Exposure: The individual is exposed to HSV.
Incubation Period: Typically 5-12 days.
Prodromal Symptoms: Some individuals may experience fever, fatigue, and general malaise before the rash appears.
Rapid Development of Rash: Clusters of small, painful, itchy blisters (vesicles) appear quickly, usually on areas affected by eczema.
Progression of Lesions: Blisters may erode, bleed, and crust over. The rash can spread rapidly.
Systemic Symptoms: Fever, swollen lymph nodes, and other systemic symptoms may develop.
Healing: With treatment, the lesions will begin to crust over and heal within a few weeks. Without treatment, the outbreak can last longer and lead to complications.
Important Considerations
Emergency Situation: Eczema herpeticum can be a life-threatening infection, especially in infants and young children. Seek immediate medical attention if you suspect someone has EH.
Risk of Complications: Complications can include:
Secondary bacterial infections.
Herpes simplex keratitis (eye infection), which can lead to blindness.
Encephalitis (brain inflammation).
Disseminated infection (spread of the virus throughout the body), which can be fatal.
Prompt Treatment is Crucial: Early diagnosis and treatment with antiviral medications are essential to prevent complications and improve outcomes.
Differential Diagnosis: It's important to differentiate EH from other skin conditions, such as impetigo, varicella (chickenpox), and Kaposi varicelliform eruption caused by other viruses.
Recurrence: EH can recur, especially in individuals with frequent herpes simplex outbreaks or chronic skin conditions.
Mental Health: Eczema Herpeticum can be very painful, and the fear of spreading the virus or having visible lesions can impact mental health. Mental health support is an important part of treatment.