Author: Dr Stanley Leong, Dermatology and Paediatric Registrar, Christchurch, 2023. Reviewing dermatologist: Dr Ian Coulson
Edited by the DermNet content department
A 4-month old infant presented with severe exacerbation of eczema and poor feeding.
On examination, he has low grade fever with multiple monomorphic clustered vesicles over his face, neck, trunk and legs. He is mildly dehydrated.
Eczema herpeticum is also known as Kaposi varicelliform eruption. It is a skin infection caused by Herpes simplex virus (HSV) type I and II.
It most commonly develops in individuals who already have atopic dermatitis/eczema.
Eczema herpeticum can cause an acute exacerbation of eczema. It is usually very painful and young children can be unwell with fever and swollen lymph nodes.
Eczema herpeticum can become infected with bacteria, commonly Staphylococcus or Streptococcus. Secondary bacterial infection can lead to impetigo or cellulitis.
It can cause herpetic keratitis if the eyes are infected by HSV from the surrounding lesions, which if left untreated, can lead to blindness.
Eczema herpeticum is considered as one of the few dermatological emergencies. Prompt treatment with antiviral medication (eg, aciclovir, valaciclovir) should eliminate the need for hospital admission.
