This 4-year-old boy with atopic dermatitis developed a pruritic eruption typical of a primary cutaneous Herpes simplex virus(HSV) infection. Eczema herpeticum, also known as Kaposi's varicelliform eruption, represents widespread cutaneous HSV in patients with pre-existing skin disorders. Atopic Dermatitis is by far the most common underlying associated skin condition. Other disorders that predispose patients to this primary HSV infection include keratosis follicularis, pemphigus foliaceous and icthyosis vulgaris. The differential diagnosis includes widespread impetigo, scabies, papular urticaria, contact dermatitis, and shingles. Many patients have a history of exposure to a family member with recurrent HSV infection. A Tzanck preparation is a useful bedside diagnostic technique, but viral culture is confirmatory.
Eczema herpeticum is treated with oral antiviral medications, tap water and/or aluminum acetate compresses 2 or 3 times a day, and oral antipruritics. Early and aggressive therapy of secondary infection is necessary. Infants with high fever, poor oral intake, and evidence of secondary infection, may require inpatient management with intravenous acyclovir and antibiotic coverage.
widely scattered clusters of 2-3 mm excoriated red, papules, vesicles, and crusts