II. Epidemiology
- Age
- More common in children (immature Immune Systems)
III. Pathophysiology
- Skin infected by Herpes Simplex Virus infection
- Infections are typically in patients with skin barrier defects (see risk factors as below)
IV. Risk Factors
- Atopic Dermatitis
- Burn Injury
- Post-operative complication (e.g. Cosmetic dermatology procedure)
- Inflammatory skin conditions
V. Symptoms
- Painful papulovesicular rash spread over localized skin region
VI. Signs
- Characteristics
- Distribution
- May affect any region with Atopic Dermatitis
- Head
- Face
- Neck
- Chest
- Severity
- Atopic Dermatitis severity correlates with Eczema Herpeticum severity
- Children are prone to more severe cases
- Associated findings
- Fever
- Lymphadenopathy
- Other systemic herpetic complications
- Herpes Simplex Keratitis (Keratoconjunctivitis)
- Herpes Gingivostomatitis
- HSV Encephalitis (Meningoencephalitis)
VII. Labs
- HSV PCR
- Other laboratory testing as indicated (e.g. septic workup with Blood Cultures)
- Consider MRSA swabs (if superinfection suspected)
VIII. Differential Diagnosis
- See Vesicle
- Impetigo
- Hand Foot and Mouth Disease
- Varicella Zoster Virus
- Herpes gladiatorum
X. Management
- Dermatologic emergency requiring prompt initiation of Antiviral therapy
- Consult dermatology
- Inpatient management is typical with IV Antivirals (esp. children)
- Initiate IV Acyclovir (and follow Renal Function)
- Transition to oral Acyclovir or Valacyclovir
- Treat superinfections (e.g. MSSA, MRSA)
- Symptomatic management
- Skin Emollients (e.g. petroleum jelly)
- Topical antibacterial as needed (e.g. Mupirocin)
- Medium potency Topical Corticosteroids may be considered (e.g. Triamcinolone cream)