Eczema herpeticum is a viral skin infection that can affect individuals with pre-existing skin conditions like eczema. It is a complication arising from infection with the herpes simplex virus (HSV) in people whose skin barrier is compromised. This condition requires prompt attention due to its potential for rapid progression and severe health implications.
Understanding Eczema Herpeticum
Eczema herpeticum is caused by the herpes simplex virus (HSV), most commonly HSV-1, the same virus responsible for cold sores. HSV-2, typically associated with genital herpes, can also be a cause. Unlike typical localized herpes infections, the virus in eczema herpeticum spreads extensively across skin already affected by eczema.
The compromised skin barrier in individuals with eczema, particularly atopic dermatitis, makes them more susceptible to this widespread viral infection. This weakened barrier allows the virus to penetrate and spread. People with moderate to severe eczema or those with a history of recurrent skin infections face a higher risk.
The body’s immune response in individuals with eczema may also be altered, potentially reducing their ability to fight off HSV effectively. This condition differs from a typical eczema flare-up or other common skin infections because it is a specific viral infection, not a bacterial or fungal issue.
Recognizing the Signs
The characteristic rash of eczema herpeticum involves clusters of small, fluid-filled blisters. These blisters can appear on skin already affected by eczema or on seemingly healthy skin. As the condition progresses, these lesions may rupture, creating distinctive “punched-out” erosions that can then crust over or bleed.
While the rash can occur anywhere on the body, it is frequently observed on the face, neck, and torso. The lesions can be painful and itchy.
Along with the skin manifestations, individuals often experience systemic symptoms. These can include a sudden onset of fever, a general feeling of unwellness (malaise), and swollen lymph nodes near the affected areas. The rash and associated symptoms progress rapidly, often worsening over 7 to 10 days, which helps distinguish it from other slower-developing skin conditions.
Prompt Medical Intervention and Treatment
Eczema herpeticum is considered a dermatologic emergency, requiring immediate medical attention. Seeking care at an emergency room or urgent care clinic is important due to the risk of serious complications if left untreated. Early diagnosis is often made based on the characteristic clinical appearance, though a viral swab from a blister can confirm the presence of HSV.
Treatment involves antiviral medications such as acyclovir, valacyclovir, or famciclovir. These medications can be administered orally for milder cases or intravenously for more severe infections, or if the patient is unable to take oral medication. Starting antiviral therapy as soon as possible is important to minimize the spread of the virus and reduce the severity and duration of the outbreak.
Supportive care is also a component of management. This may include antibiotics to address any secondary bacterial infections that can arise from the compromised skin barrier, as well as pain relief medications. Proper wound care for the lesions helps promote healing and prevents further complications. Untreated eczema herpeticum can lead to serious complications, including the spread of the virus to the eyes, potentially causing vision loss, or to internal organs like the brain (encephalitis) or liver, which can be life-threatening.
Minimizing Risk and Spread
Preventing future episodes of eczema herpeticum involves managing underlying eczema to maintain a healthy skin barrier. Regularly moisturizing and adhering to prescribed eczema treatments can help fortify the skin’s natural defenses. Identifying and avoiding known triggers for both eczema flares and HSV outbreaks, such as stress or excessive sun exposure, is also important.
To prevent the spread of the virus during an active outbreak, strict hygiene practices are important, including frequent hand washing. Individuals should avoid touching or picking at the lesions, as this can spread the virus to other parts of their own body or to others. Sharing personal items like towels, eating utensils, or drinking glasses should be avoided.
During an active outbreak, it is advisable to limit close physical contact with others, especially with vulnerable individuals such as infants, pregnant women, and those with weakened immune systems. In cases of frequent recurrences, a healthcare provider might consider prescribing suppressive antiviral therapy to help prevent future outbreaks.