Derm Dx: Widespread umbilicated vesicles - Clinical Advisor

Derm Dx: Widespread umbilicated vesicles

Slideshow

  • EczemaHerpeticum_Hands

  • EczemaHerpeticum_Eye

  • Hepatitis C and eczema?

    EczemaHerpeticum_Neck

  • EczemaHerpeticum_Face

  • EczemaHerpeticum

Clinical Description

A widespread rash that begins as clusters of umbilicated vesicles and spreads over a period of seven to 10 days, sometimes accompanied by fever, malaise and lymphadenopathy.

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Eczema herpeticum is a widespread cutaneous herpes simplex virus infection that occurs in people who have preexisting skin disorders such as atopic dermatitis, and Darier's disease. The rash often resembles smallpox with vesicular lesions that coalesce into large erosions that...

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Eczema herpeticum is a widespread cutaneous herpes simplex virus infection that occurs in people who have preexisting skin disorders such as atopic dermatitis, and Darier’s disease. The rash often resembles smallpox with vesicular lesions that coalesce into large erosions that can become infected with other bacteria. Clinicians should confirm HSV with viral cultures from skin lesions using a Tzanck preparation.

Treatment

Acyclovir is commonly used to treat eczema herpeticum. Dosing for severe cases in immunocompromised patients is 15 mg per kg per day IV for at least five days. Adults with less severe cases can be treated with 400 mg oral acyclovir five times daily for five to 10 days. Pediatric dosing is 25 mg per kg per day oral acyclovir in five equal doses for five to 10 days.

Clinicians should consider oral and IV pain medications if there is diffuse involvement and oral antibiotics for secondary infections, particularly an antibiotic with Staphylococcal coverage. If there is no evidence of a superinfection, topical antibiotics such as silver sulfadiazine can be used preventively.

Patients with a history of recurrent HSV-1 and HSV-2 infections may be prescribed prophylactic antiviral therapy with 400 mg oral acyclovir twice daily or 500 mg to 1 g oral valacyclovir once a day.

Primary eczema herpeticum episodes resolve within two to six weeks; however, patients with chronic skin damage may experience milder recurrent episodes that are not associated with systemic symptoms.

Differential diagnosis may include widespread impetigo and Kaposi’s varicelliform eruption caused by vaccinia virus.

Complications

Eczema herpeticum can progress to hepatitis herpes and other life-threatening conditions if left untreated. Laboratory examination for patients with systemic illness should include CBC count, as well as platelet and liver function tests. Clinicians should refer patients that have multiple erosions to an opthamologist to rule out herpes keratitis.

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