Everything about Eczema Herpeticum

Eczema Herpeticum is a medical emergency and requires immediate treatment. In this article, we shall take a closer look at this clinical condition.

What is Eczema Herpeticum?

Eczema Herpeticum is a skin condition that is caused by the herpes simplex virus. In the medical world, it is also known as Kaposi Varicelliform eruption. Patients who suffer from Eczema Herpeticum often have underlying atopic dermatitis. The condition is typically more common in children and if left untreated can progress rapidly and can result in death. It affects around one in five children in developed countries.

What causes Eczema Herpeticum?

Eczema Herpeticum is caused by the herpes simplex 1 virus (HSV 1). In patients who suffer from clinical conditions such as atopic dermatitis, Eczema and burns, viral infection with the herpes simplex virus can occur which then progresses to Eczema Herpeticum.

Besides the sharpest simplex 1 virus, the herpes simplex 2 virus, Coxsackie virus A16 and the vaccinia virus have also been implicated in the development of Eczema Herpeticum.

The underlying risk factors in the development of Eczema Herpeticum are multiple and can include neuroendocrine factors, reduced immunity, defective defences in the skin and genetic factors. Long-term use of creams that are rich in steroids can also cause this condition.

Eczema Herpeticum is also associated with certain in conditions such as seborrhoeic dermatitis, psoriasis, pemphigus vulgaris and cutaneous T-cell lymphoma, to name but a few.

Clinical features

Patients who suffer from Eczema Herpeticum will initially notice slight changes in the skin such as the development of small papular lesions that eventually become fluid filled vesicles. Over time, these vesicles tend to rupture and underneath them are present a small ulcer. Around the ulcer, the skin appears rather red and inflamed. These ulcers tend to join each other, ultimately forming an island of denuded tissue that is prone to secondary infection.

Typically, Eczema Herpeticum affects the face, neck and the upper part of the chest and back. It has a predilection to mucosal surfaces and tends to occur on the lips and within the mouth. Along with the skin lesions, patients also experience fever, generalised tiredness and enlargement of the lymph nodes. Eczema Herpeticum that has affected the eyes must be treated as an ophthalic emergency.

Another characteristic feature of Eczema Herpeticum is that once it has been treated, there is a high chance of recurrence. Furthermore, super added infection such as that with staphylococcus aureus may worsen the condition.

Diagnosis

In order to treat Eczema Herpeticum effectively, patients must be diagnosed early and treated immediately. The best way to diagnose Eczema Herpeticum is to perform a swab of the vesicular lesions and a culture in a microbiology laboratory. Culture results often yield a growth of the herpes simplex virus. Additional tests such as Tzank test may be performed to look for the presence of multi-nucleated giant cells which are typical of herpes simplex infection. Furthermore, specialised test such as direct fluorescence antigen testing may help though may not necessarily be required to make a diagnosis.

Treatment of Eczema Herpeticum

Eczema Herpeticum is a medical emergency and requires immediate treatment. The typical treatment is anti-viral medication acyclovir that varies in dose depending upon the immune status of the patient. In patients who have mild disease, a dose of acyclovir 400 mg five times a day is given for 5 to 10 days. This often helps clear of the condition completely. However, in patients who have low immune levels or in those who have severe disease, a higher dose of acyclovir is required and is usually prescribed at 15 mg per kilogram per day through the intravenous route for at least five days. This is because the chances of dying from Eczema Herpeticum in limine compromise patients is a lot higher and reported to be anywhere between 6 - 10% (some have reported even higher death rates).

It is essential that all patients who have any form of skin disease and concern regarding it visit their doctor to receive treatment without delay. The above doses are what is prescribed and should not be used as a guideline to self medicate.

The lesions of Eczema Herpeticum can sometimes be quite painful. In such cases, doctors will prescribe painkillers that can help alleviate the pain. Most cases do not require intravenous medication and oral treatment is sufficient. However, when the extent of the disease is severe and the degree of pain is unbearable, intravenous medication is required in a hospital setting.

As previously mentioned above, staphylococcus aureus can result in a super added infection which can worsen the symptoms of Eczema Herpeticum. If this form of bacterial superinfection is suspected, additional antibiotics will be required. However, if no bacterial superinfection has occurred and the ulcers are open and prone to developing the infection, then covering them with a topical application of some form of antibiotic cream is often sufficient.

Eczema Herpeticum is notorious and recurring and hence many patients may require long-term preventative treatment. Medicine that is prescribed includes anti-viral therapy which is given once or twice a day for a period of months if needed. Once again, these kinds of doses and any drugs that are prescribed in managing or preventing Eczema Herpeticum must be done so by a registered medical practitioner.

Conclusion

Eczema Herpeticum is a serious clinical condition characterised by the formation of papules and vesicles on the skin. The underlying viral cause is the herpes simplex virus and super added infection with staphylococcus aureus can make treatment rather difficult. Patients must be commenced on intravenous therapy in severe cases and oral therapy in mild cases as soon as possible. If required, bacterial infections should be treated with antibacterial medication. Long-term outcomes are variable and recurrence rates are high, warranting preventative and regular therapy.



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