Eczema herpeticum is a viral infection of the skin which is usually caused by herpes simplex virus and it is characterized by the appearance of cutaneous vesicles on the skin surface which prove to erupt and is typically also accompanied with a fever [1]. Herpeticum eczema is considered to generally arise from preexisting skin diseases such as atopic dermatitis or even psoriasis. While herpeticum eczema can affect both men and women with an equal chance, it has been observed that children and young adults are more likely to be affected by this disease. Initially this condition was first described by Kaposi and therefore the disease is also known as Kaposi varicelliform eruption.

Herpeticum eczema is considered to be a very serious and life threatening condition. It is classified to be a super infection and despite the progresses and advancements that medical science has made to this day, outbreaks of herpeticum eczema are still considered to be medical emergencies in the field of dermatology.

The clusters of vesicles which appear on the surface of the skin prove to blisters which have eroded and have been punched or flattened out. The condition proves to be very itchy and the urge to scratch is very high. The blisters somewhat resemble the infection caused by the varicella virus such as chicken pox.

Herpeticum eczema is widely considered to be a complication that has been developed out of atopic eczema. The condition usually manifests in the locations of the skin where there has already been damage done due to excessive scratching because of the blisters and rashes caused by atopic eczema. Long term usage of some particular types of drugs such as topical steroids, burns and other forms of eczema can also lead to lesions being developed on the skin surface which may further on complicate into herpeticum eczema.

The condition of herpeticum eczema is quite rare and it is much less often diagnosed as compared to other forms of eczema such as atopic eczema.

While the simplex herpes virus type I and type II prove to be the primary causes of developing herpeticum eczema, the condition can also be developed due to infection by the vaccinia virus or the coxsackievirus.

The infection associated with herpeticum eczema can prove to spread at a rapid pace and may prove to affect multiple organs of the body. Proper medical attention needs to be provided in case herpeticum eczema is diagnosed as the condition can prove to be fatal.

Causes of Herpeticum Eczema

It is generally agreed upon that the primary cause of developing conditions of herpeticum eczema is due to infection by the simplex herpes virus of type I and type II. The condition typically manifests itself during the first episode of a herpes infection. Conditions may range from anything between mild to moderate to severe and needs to be provided with immediate and appropriate medical attention.

Herpeticum eczema may be usually developed in an individual if there is a breakdown of the skin barrier, leading to higher chances of infection. The barrier of the skin may breakdown if:

  • An individual has suffered a case of a thermal burn
  • An individual is infected with pemphigus vulgaris
  • An individual suffers from Darier disease
  • An individual suffers from lymphoma of the cutaneous T cells of the body
  • An individual suffers from ichthyosis

In some special cases, it has also been reported that infection by the vaccinia virus or the coxsackievirus may also lead to an individual developing conditions of herpeticum eczema [2].

In extremely rare cases, use of some discarded or discontinued vaccines, such as the discarded small pox vaccine may also lead to individuals developing the signs and symptoms of herpeticum eczema.

Signs and symptoms of Herpeticum Eczema

Herpeticum eczema signs and symptoms can vary depending on the severity of the condition. However, typically, the condition proves to occur primarily around the neck region and the face region. Other regions of the body vulnerable to developing the rashes and blisters are areas which have suffered an injury or areas which were earlier affected with atopic eczema.

The signs and symptoms of herpeticum eczema manifest themselves within 5 to 12 days after contact with the simplex herpes virus. The sores on the skin surface may not appear immediately on infection and may prove to manifest themselves in some time.

While the blisters may prove to be localized to one region, they may also prove to spread to other areas of the body and must be treated with immediate care. The blisters often prove to be both painful and itchy.

Herpeticum eczema also manifests itself alongside the appearance of a number of other signs and symptoms. These include the following:

  • The individual generally feels unwell and has a fever
  • The lymph nodes of an affected individual appear to be swollen
  • All of the blisters appear to be exactly alike in shape and structure
  • The blisters or vesicles are all filled with pus or a yellowish brown fluid
  • The vesicles are often stained with blood and hence appear to be dark red, purple or sometimes even brown or black in color
  • There is an umbilication or the formation of depressions in new blisters
  • Blisters often prove to erupt and ooze out liquid
  • The dried blisters form crusts which prove to be very itchy once again

The signs and symptoms of herpeticum eczema typically last for a period of in between 2 to 6 weeks. In some cases where the skin surface proves to be destroyed by the viral infection, white scars will remain on the skin surface even years after herpeticum eczema conditions disappear.

In some cases the blisters associated with herpeticum eczema may prove to affect multiple organs of the body including the eyes, the lungs, the liver and even the brain and it is a serious and a potentially fatal disease [3].

Herpeticum eczema is also very often accompanied with a number of other infections such as the development of conditions of cellulitis and impetigo due to infection by the staphylococci or streptococci bacteria families.

In severe conditions of herpeticum eczema, the blisters may spread and other organs of the body may also prove to get infected. In case vital organs such as the lungs, the liver, the eyes or the brain prove to be infected, the condition can prove to be very serious and potentially life threatening.

Herpeticum eczema is an acute complication that is developed out of an injury to the skin surface or due to complications associated with conditions of atopic dermatitis. As such, if the signs and symptoms of the condition are managed effectively and the condition is alleviated, it is rare for herpeticum eczema to recur in individuals. However, atopic eczema is a chronic condition and each and every episode of flare ups associated with atopic eczema present along with it the risk of complications of herpeticum eczema. As such, any sufferer of atopic eczema will always need to maintain care and protect the skin throughout every flare up or bout of blister outbreaks.

Diagnosis of Herpeticum Eczema

There are several techniques that are employed in order to confirm the diagnosis of herpeticum eczema conditions [4]. The exact viral infection can be determined by obtaining swabs of viral culture from the base of an actively erupt vesicle or blister. After this has been done, several tests may be performed on the swab to confirm diagnosis, which include the following:

  • Performing a viral culture test
  • Performing a test for direct fluorescent stain of antibodies
  • Performing a polymerase chain reaction sequencing test
  • Performing tzank smear tests

It is not just viral culture swabs, but even bacterial swabs need to be obtained and tested under microscopic techniques. This is because the signs and symptoms of herpeticum eczema may prove to resemble those of impetigo and can greatly be infected in case of a bacterial infection.

In extremely rare cases, a biopsy is performed on a skin patch in order to confirm the diagnosis of herpeticum eczema.

Treatment for Herpeticum Eczema

Herpeticum eczema is one of the few emergencies in the field of dermatology. While the condition can prove to be very serious and potentially life threatening for an individual, if treatment measures are available at hand and antiviral medication is administered, an individual need not be admitted into a hospital.

Some of the common medications that prove to be of great help in controlling the signs and symptoms of herpeticum eczema include the following:

  • The use of antiviral medication in oral form such as acyclovir and valacyclovir
  • The use of antibiotics in order to ward off bacterial infections

In case the use of oral medication proves to be ineffective, then injections of antiviral medication may be used.

The use of topical steroids generally does not prove to be of much help in the treatment of herpeticum eczema but in case conditions of atopic eczema also exist alongside, then the use of such creams and ointments may become necessary.

In case the blisters and the skin lesions happen to appear around sensitive regions such as the eyes, it is best to seek a professional specialist for treatment at the earliest.

In some special cases, herpeticum eczema proves to be caused due a weak immune system of an individual. If such a case is confirmed, then the use of foscarnet proves to be great in the treatment of herpeticum eczema.

Herpeticum eczema proves to be a serious complication that develops out of conditions of atopic eczema. While other types of eczema are generally not life threatening and only cause to prove discomfort, irritation and embarrassment, herpeticum eczema can prove to affect some of the most vital organs of the body. Usually, if babies encounter this infection, their condition deteriorates at a rapid pace and also proves to be fatal in a number of cases. If you suspect that you or someone that you know could be suffering from conditions of herpeticum eczema, you must ensure to seek professional medical help and guidance at the earliest. The condition can be easily diagnosed and managed, but it is a medical emergency and must be provided with prompt and immediate medical attention.

It is also known that sufferers of atopic eczema have a much lower level of immunity and if they come into contact with a person infected with the simplex herpes virus, they may prove to develop conditions of herpeticum eczema.

Herpeticum eczema must be taken very seriously. It is best to try and keep the skin surface as protected as possible during outbreaks or flares of atopic eczema and never to indulge in too much scratching of the blisters [5]. Preventing the occurrence of herpeticum eczema is the best way to avoid a potentially life threatening complication.

 

References


[1] Genetic Variants inTSLP are Associated with Atopic Dermatitis and Eczema Herpeticum, Pei-Song Gao, Nicholas M Rafaels,  Deguang Mu;  PMC2925504- 2011 Jun 1- DOI:  1016/j.jaci.2010.03.016http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2925504/


[2] Delayed Acyclovir and Outcomes of Children Hospitalized With Eczema Herpeticum, Paul L. Aronson, Albert C. Yan, Manoj K. Mittal; pp. 1161 -1167- November 14, 2011 DOI: 10.1542/peds.2011-0948, http://pediatrics.aappublications.org/content/128/6/1161.short


[3] A Case of Eczema Herpeticum with Hailey-Hailey Disease, Gun Hong Lee,Yun Mi Kim, Sung Yul Lee; 21(3):311-314- 2009 Aug- DOI:10.5021/ad.2009.21.3.311http://synapse.koreamed.org/DOIx.php?id=10.5021/ad.2009.21.3.311&vmode=FULL


[4] Management of atopic eczema in children aged up to 12 years: summary of NICE guidance, Sue Lewis-Jones, Sue Lewis-Jones; PMC2137073- 2007 Dec 15- DOI:  10.1136/bmj.39405.503773.ADhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2137073/


[5] Research statistics in Atopic Eczema: what disease is this?, Kam-Lun Ellis Hon, Vivien Yong, and Ting-Fan Leung; PMC3413563- 2012 Jun 9- DOI:  10.1186/1824-7288-38-26