Eczema herpeticum Path: Inflammatory & Vasculitic Skin Conditions
Eczema Herpeticum
Eczema herpeticum (Kaposi varicelliform eruption) is an acute, potentially life‑threatening disseminated herpes simplex infection of disrupted skin.
It classically presents as rapid onset clustered vesicles and “punched‑out” erosions on a background of atopic dermatitis or other eczematous skin, often accompanied by fever and systemic toxicity.
Prompt recognition and immediate systemic antiviral therapy are essential to prevent ocular, neurological and systemic complications (NICE CG57, QS44).
Clinical context and risk factors
- Most cases are due to herpes simplex virus type 1 or 2, usually following primary exposure; incubation is typically 5-12 days.
- Major risk factors include atopic dermatitis (most common), other chronic eczemas with barrier disruption, widespread skin breakdown and immunosuppression.
- Children with atopic eczema require particular vigilance; NICE recommends immediate systemic aciclovir and same‑day specialist dermatology advice (NICE CG57, QS44).
Typical presentation
- Skin: abrupt worsening of eczema with groups of small uniform vesicles or pustules evolving to shallow, punched‑out erosions (often 1-3 mm) that may coalesce.
- Lesion symptoms: lesions can be painful or intensely pruritic.
- Systemic: fever, malaise, lethargy and regional lymphadenopathy; may progress to systemic toxicity in severe or disseminated disease.