Occurrence of Eczema Herpeticum

Eczema herpeticum, initially described by Kaposi in 1887, is a potentially life-threatening herpetic super infection of a pre-existing skin disease. Despite the availability of antiviral therapies, eczema herpeticum remains a dermatological emergency today.

This occurs as a result of the eczema being infected with the herpes simplex virus, the virus that produces cold sores. It is important to avoid skin contact with anyone who has cold sores.

Normally, herpes simplex will be confined to cold sores around the mouth and is a routine condition. However, in a person with eczema the virus can appear anywhere on the skin. In rare cases, it can prove fatal.

Causes of Eczema Herpeticum

One of the most serious complications with atopic eczema is eczema herpeticum, this develops when eczema becomes infected with the herpes virus. Eczema herpeticum is a serious condition and medical help must be sought. The symptoms of eczema herpeticum may include a high temperature; an extensive rash with small skin blisters filled with yellow pus and you may generally feel unwell. The rash can cover the whole of the skin surface. Eczema herpeticum can occur when anyone with eczema, especially if it is sore and open has skin-to-skin contact with someone who has active facial (cold sores) or genital herpes.

The cause of eczema herpeticum is always HSV type I. The exact pathophysiology is unknown, but it is thought to involve HSV entering the skin when skin barrier function is compromised due to dermatitis. Defective cytokine secretion in the affected skin also plays an important role.

The severity of preexisting eczema does not seem to dictate the severity of eczema herpeticum. Secondary bacterial skin infections are very common. A mixture of aerobic and anaerobic bacteria are commonly isolated, the most common being S aureus, Group A ß-hemolytic Streptococcus, Pseudomonas, and Peptostreptococcus.

Symptoms of Eczema Herpeticum

Eczema herpeticum appears in small clusters and looks like blisters or ulcers. These are initially filled with a clear fluid but this turns to pus. The blisters are scratched and become raw and weepy.

If your eczema becomes worse for no apparent reason or you see blisters on the surface, medical advice is required. With eczema herpeticum the sufferer may have a high temperature and feel very ill. Be sure to explain all your symptoms to your doctor because this is not a straightforward condition to diagnose.

When herpes simplex, the virus that causes cold sores, enters an atopic dermatitis skin lesion, it can cause eczema herpeticum - a severe and potentially life-threatening infection. While not common, eczema herpeticum occurs in people of all ages and in males and females. Often those infected do not know that they have been exposed to the herpes simplex virus.

The first indication of infection occurs 5 to 12 days after exposure to the virus and typically appears as multiple itchy, watery blisters that occur on skin previously affected by atopic dermatitis. If these blisters are not treated, they can become progressively worse as illustrated by these stages:

  1. Multiple itchy, watery blisters over an area of skin, usually where atopic dermatitis lesions were present (5 to 12 days after exposure).
  2. Blisters tend to disseminate or "crop" into adjacent areas of skin.
  3. Blisters may bleed, become encrusted, and erode - at this stage they are extremely painful.
  4. The viral infection spreads to cover the entire body, with associated fever and swollen lymph nodes. Secondary bacterial infection frequently develops in large, eroded areas of skin.

During all stages, fever is usually present and the person feels ill. The first episode of eczema herpeticum usually runs its course in 2 to 6 weeks if left untreated. However, letting the disease run its course is not recommended as eczema herpeticum can be life threatening. Subsequent outbreaks tend to be milder, unless the patient has an underlying immunodeficiency condition.

Controlling Eczema Herpeticum

Since eczema herpeticum is potentially life threatening, medical care should be sought. When therapy begins early, eczema herpeticum can be effectively treated. Several anti-viral medications are available, and a dermatologist can prescribe the one best suited for the individual. Pain medications also may be helpful.

Other viruses that may complicate atopic dermatitis include molluscum contagiosum and human papillomavirus. If a virus is suspected, a dermatologist may order diagnostic tests to determine which virus is involved so that proper therapy can be prescribed.

However, considering how common the herpes simplex virus and atopic eczema are, this condition is fortunately quite rare.