Eczema Herpeticum

Abstract

Eczema herpeticum is an easily missed entity most commonly seen in the pediatric population and carries the risk of systemic compromise and a 10% mortality rate. Clinicians should maintain high clinical suspicion when encountering children or young adults with a history of atopic dermatitis or other erosive dermatoses and who present with vesicular lesions, punched-out erosions, and systemic symptoms. We present 3 severe cases of eczema herpeticum that were potentially overlooked and demonstrate the need for elevated awareness to avoid potential pitfalls.

An 8-Month-Old Girl With Vesicular Rash

“…EH is an easily missed entity and may lead to multiple organ system compromise if not treated promptly. 2 With increased use of antimicrobial therapy, mortality rates are low. 3,4…”

“…Epidermal barrier breakdown of the stratum corneum may create an environment for HSV to grow. 2 Impairment in both cell-mediated and humoral immunity in addition to increased Th-2 cytokine levels may predispose to EH. 1,2 AD patients are often colonized with pathogenic Staphylococcus .…”

“…2 Impairment in both cell-mediated and humoral immunity in addition to increased Th-2 cytokine levels may predispose to EH. 1,2 AD patients are often colonized with pathogenic Staphylococcus . This leads to high bacterial superinfection rates with EH.…”

“…Ninety percent of pediatric cases are secondarily infected with Staphylococcus aureus or group A Streptococcus . 2,10 Fortunately, overall mortality rates are extremely low.…”

“…Sometimes, skin lesions may not appear with the characteristic findings of grouped vesicles on an erythematous base. 1,2,11 Some patients may develop systemic symptoms including fever, malaise, and lymphadenopathy. Differential diagnosis may include impetigo, arthropod bites, scabies, papular urticaria, varicella, and bacterial superinfection.…”