Eczema herpeticum is a viral skin infection that happens when the herpes simplex virus spreads across skin affected by eczema or another skin condition. It can cause groups of similar-looking, painful or itchy blisters that may break open and form sores. The infection can spread quickly and sometimes affect the eyes or other organs, so suspected eczema herpeticum needs urgent medical assessment and prompt antiviral treatment.
According to Cleveland Clinic, eczema herpeticum is an uncommon but potentially serious condition that most often affects people with atopic dermatitis, a common type of eczema. It is also known as Kaposi varicelliform eruption. Although it can be treated successfully, early medical care is important because the infection may worsen without appropriate treatment.
What causes eczema herpeticum?
Eczema herpeticum is caused by the herpes simplex virus (HSV), the same family of viruses responsible for cold sores and genital herpes. HSV type 1 (HSV-1) causes most cases, although HSV type 2 (HSV-2) can also be responsible. The virus may enter through skin affected by eczema or spread across an already vulnerable skin barrier.
According to DermNet, the infection often develops during a person's first herpes simplex infection, but it can also occur when an existing infection becomes active again. A person may acquire the virus through direct contact with an infected area, including contact with a cold sore. The person carrying the virus may not always have a visible sore.
Who is more likely to develop eczema herpeticum?
Eczema herpeticum can occur at any age, but it is particularly associated with atopic dermatitis. Infants and children with eczema are important groups to protect because the infection can make them seriously unwell. People with weakened immune systems and those with other conditions that damage the skin barrier may also be at increased risk.
- People with atopic dermatitis, especially when the skin barrier is damaged.
- Infants and young children with eczema.
- People with weakened immune systems.
- People exposed to herpes simplex through direct contact with infected skin or sores.
Having eczema does not mean that someone will develop eczema herpeticum. The condition occurs when herpes simplex infection affects susceptible skin, and it is not the same as an ordinary eczema flare.
What does eczema herpeticum look and feel like?
Eczema herpeticum often causes clusters of blisters that look similar to one another. They may be itchy, tender or painful, and new groups can appear over a short period. The rash commonly affects the face and neck, particularly in people with eczema, although other body areas can be involved.
The American Academy of Dermatology describes symptoms that can include a blistering rash, pain, fever, tiredness and swollen lymph nodes. As the infection develops, blisters may break open, release fluid, bleed or form crusted sores. These features are examples of what may occur; other skin infections can produce similar changes.
- Groups of small, similar-looking blisters.
- Itchy, tender or painful patches of affected skin.
- Blisters that break open and develop into shallow sores or crusts.
- Fever or chills.
- Feeling unusually tired or generally unwell.
- Swollen lymph nodes near the affected area.
The rash may initially resemble an eczema flare or another skin infection. However, a sudden appearance of painful or closely grouped blisters on eczema-affected skin, particularly with fever or feeling unwell, raises concern for a possible infection that needs prompt assessment.
When does eczema herpeticum require urgent medical attention?
Suspected eczema herpeticum should be assessed urgently because delaying antiviral treatment can allow the infection to spread. The NHS advises urgent medical assessment when eczema becomes blistered, crusty, painful, swollen or suddenly worse, particularly when fever or feeling generally unwell accompanies these changes.
Seek immediate medical attention if a person with eczema develops a rapidly spreading blistering rash or appears increasingly unwell. Blisters near the eyes, eye pain or changes in vision are especially concerning because the infection can affect the eye and threaten sight. Infants and young children with suspected eczema herpeticum need prompt medical evaluation.
How is eczema herpeticum diagnosed?
A healthcare professional usually begins by examining the affected skin and asking about the person's eczema history, when the rash appeared, how quickly it has changed, and whether there has been contact with someone who has a cold sore or another herpes infection. The appearance and distribution of the blisters can help guide the assessment.
According to Cleveland Clinic, a clinician may collect a sample from a blister using a swab to test for herpes simplex virus. A sample may also be checked for bacteria when a secondary bacterial infection is suspected. Testing can help clarify the cause, but treatment may need to begin promptly when clinical findings strongly suggest eczema herpeticum.
Other conditions can cause blistering, open sores or crusted skin, including bacterial infections and other viral skin conditions. A healthcare professional considers the examination findings and relevant history to distinguish these possibilities and determine the appropriate treatment.
How is eczema herpeticum treated?
Treatment involves prescription antiviral medicine that targets the herpes simplex virus. A healthcare professional may prescribe acyclovir or valacyclovir, depending on the person's circumstances. Prompt treatment helps control the infection and reduces the risk of complications.
People who are significantly unwell, have extensive infection or cannot take oral medication may need hospital assessment and antiviral treatment through a vein. The choice of treatment depends on the person's condition and the extent of infection.
If bacteria have also infected the affected skin, a clinician may prescribe antibiotics. These medicines treat the bacterial infection, not the herpes virus itself. If the rash involves the eyes or nearby skin, an urgent eye assessment may also be necessary.
People should follow the prescribed treatment plan and ask their healthcare professional how to manage their usual eczema medicines during the infection. Treatment decisions about topical corticosteroids or other eczema therapies should be individualized rather than made by stopping or restarting medication without guidance.
Can eczema herpeticum cause complications?
Eczema herpeticum can sometimes lead to complications, particularly when treatment is delayed or the infection spreads beyond the skin. A secondary bacterial infection may develop in the damaged areas. In uncommon cases, the virus can affect the eyes or spread to other organs.
The Merck Manual Professional Edition describes eczema herpeticum as a complication of herpes simplex infection involving eczema-affected skin. Eye involvement can cause damage to the cornea, the clear front surface of the eye. More widespread infection can be dangerous, which is why early recognition and treatment are important.
With prompt appropriate treatment, many people recover. The blisters gradually heal, although recovery time varies, and some people may develop temporary or lasting marks where the skin was damaged. Recurrence is possible but is uncommon.
How can eczema herpeticum be prevented?
Prevention focuses on reducing exposure to herpes simplex and maintaining the skin barrier. People with eczema can take practical steps to lower the chance of contact with the virus, especially when someone close to them has an active cold sore or another herpes outbreak.
- Avoid direct skin contact with active cold sores or other herpes sores.
- Do not share lip balm, lip products or items that have direct contact with an active cold sore.
- Wash hands with soap and water after accidental contact with a sore.
- Follow an appropriate eczema care plan to help protect the skin barrier.
- Keep active eczema under suitable medical care, particularly when the skin is cracked or damaged.
If someone with eczema develops new blisters after contact with a person who has a cold sore, they should seek prompt medical advice rather than waiting for the rash to settle. Avoiding exposure can reduce risk, but it cannot prevent every case.