Morning Report: Eczema Herpeticum

Here’s Dr. Kendall with today’s Morning Report!

ECZEMA HERPETICUM

(Kaposi varicelliform eruption)

Distinct cutaneous eruption caused by virus on existing dermatosis

Virus (HSV-1, HSV-2, coxsackievirus A16, vaccinia virus)

+

Dermatosis (atopic dermatitis, seborrheic dermatitis, SLE, psoriasis, etc.)

HSV + ATOPIC DERMATITIS (main combination)

PATHOPHYSIOLOGY

Cell mediated immunity:   T helper type1/T helper type 2 imbalace?

Humoral immunity:  High IgE levels?

Skin barrier dysfunction

HSV is for life

EPIDEMIOLOGY

Incidence increasing (more HSV)

Mortality decreasing 50% → 10% (IV Acyclovir)

All ages

PRESENTATION

Sudden eruption, painful vesicles

Umbilicated vesiculopustules → punched out erosions

Spreads for 1 week   →  Resolves in 2-6 weeks

Diff dx:  chickenpox, impetigo, contact dermatitis, chronic bullous disease

BADNESS

Fever, malaise, lymphadenopathy

Viremia  (liver, lungs, CNS, GI, adrenal)

Secondary Infection → Septicemia

Keratoconjunctivitis

ED MANAGEMENT

Acyclovir

Abx?

Ophtho?  (herpetic keratitis)

Work-up?  (viral culture, DFA, Tzanck, PCR, biopsy…Derm?)

Admit severe infections and immunocompromised

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• Bio
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Jay Khadpe MD

• Editor in Chief of "The Original Kings of County"
• Assistant Professor of Emergency Medicine
• Assistant Residency Director
• SUNY Downstate / Kings County Hospital

Latest posts by Jay Khadpe MD (see all)

• Save of the Month! December 2015 - December 23, 2015
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• Morning Report: Extramural Deliveries in the Emergency Room - September 10, 2015