ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferencesView all Images (46)
Potentially life-threatening emergency
Eczema herpeticum in Adult
Print Captions OFF
Other Resources UpToDate PubMed
Potentially life-threatening emergency

Eczema herpeticum in Adult

Print Images (46)
Contributors: Elizabeth B. Wallace MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Eczema herpeticum, or Kaposi varicelliform eruption, is a superficial, widespread, cutaneous infection with herpes simplex virus (HSV) 1 or 2 in a patient with pre-existing skin disease. The herpes infection may be primary and sustained from a close contact, or it may occur via autoinoculation. Vesicles, pustules, and characteristic "punched-out" erosions with hemorrhagic crust appear superimposed on areas of pre-existing skin disease. Presentation ranges from mild and transient to life-threatening.

Eczema herpeticum is more commonly seen in patients with atopic dermatitis but may also be seen in cases of Darier disease, autoimmune bullous dermatoses, burns, mycosis fungoides, pityriasis rubra pilaris, and other forms of dermatitis such as irritant contact and seborrheic dermatitis. It mostly affects children but can occur in any age group.

Risk factors that have been proposed for the development of eczema herpeticum include mutations in filaggrin and deficiency of cathelicidins, skin antimicrobial peptides, in the skin.

Patients can develop numerous vesicles that may appear in successive crops for several days. Associated systemic symptoms can include high fevers, lymphadenopathy, and malaise. The primary infection is usually more severe than recurrent episodes.

Complications of eczema herpeticum include secondary bacterial infection and multiorgan involvement, including keratoconjunctivitis, meningitis, and encephalitis. Commonly implicated pathogens in bacterial superinfection include Staphylococcus aureus and Streptococcus pyogenes. Systemic viremia can result in serious morbidity and mortality, especially in infants.

The disease is typically self-limited, lasting 2-4 weeks, but can be shortened by antiviral therapy. In healthy adult patients, mild cases can be self-limiting. In children and young infants, this condition is a medical emergency, and early treatment with antiviral therapy is required.

Codes

ICD10CM:
B00.0 – Eczema herpeticum

SNOMEDCT:
186535001 – Eczema herpeticum

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

Subscription Required

References

Subscription Required

Last Reviewed: 03/03/2017
Last Updated: 04/04/2017
Copyright © 2019 VisualDx®. All rights reserved.
Potentially life-threatening emergency
Eczema herpeticum in Adult
Captions OFF Print 46 Images Filter Images
View all Images (46)
(with subscription)
 Reset
Eczema herpeticum : Fever, Malaise, Umbilicated vesicles
Clinical image of Eczema herpeticum
A close-up of many discrete and confluent, monomorphic crusts and a few outlying vesicles.
Copyright © 2019 VisualDx®. All rights reserved.