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Potentially life-threatening emergency
Eczema herpeticum in Adult
Other Resources UpToDate PubMed
Potentially life-threatening emergency

Eczema herpeticum in Adult

Contributors: Elizabeth B. Wallace MD, Susan Burgin MD
Other Resources UpToDate PubMed


Eczema herpeticum, or Kaposi varicelliform eruption, is a superficial, widespread, cutaneous infection with herpes simplex virus (HSV) 1 or 2 in a patient with preexisting 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 preexisting 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.


B00.0 – Eczema herpeticum

186535001 – Eczema herpeticum

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Primary Varicella
  • Disseminated Herpes zoster
  • Disseminated Molluscum contagiosum
  • Bullous impetigo
  • Erysipelas
  • Contact dermatitis (Irritant contact dermatitis, Allergic contact dermatitis)
  • Dermatitis herpetiformis
  • Drug eruption general overview
  • Vesicular Viral exanthem
  • Hand, foot, and mouth disease
  • Acute generalized exanthematous pustulosis

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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.

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Last Reviewed:03/02/2017
Last Updated:02/04/2021
Copyright © 2024 VisualDx®. All rights reserved.
Potentially life-threatening emergency
Eczema herpeticum in Adult
A medical illustration showing key findings of Eczema herpeticum : Fever, Malaise, Umbilicated vesicles
Clinical image of Eczema herpeticum - imageId=270255. Click to open in gallery.  caption: 'A close-up of many discrete and confluent, monomorphic crusts and a few outlying vesicles.'
A close-up of many discrete and confluent, monomorphic crusts and a few outlying vesicles.
Copyright © 2024 VisualDx®. All rights reserved.