Eczema herpeticum is an illness caused by one of the herpes viruses. It causes a blistery skin rash. It most often affects children who have eczema. It should be treated as soon as possible to avoid complications. Treatment with an antiviral medicine usually works very well.
What is eczema herpeticum?
Eczema herpeticum is a blistery rash which makes you feel unwell. It is caused by an infection with one of the herpes viruses. It is most often caused by herpes virus type 1. This is the type of herpes virus which causes cold sores. The rash can spread very quickly over the body.
Usually the virus is caught from somebody who has an infection such as a cold sore. It takes 5-12 days after contact with the infected person for the rash to develop.
Who gets eczema herpeticum?
Eczema herpeticum can happen at any age. However, it is most common in young children. It is particularly common in young children who have atopic eczema. The eczema causes breaks in the skin which allows the virus in. So it can also happen to people who have other causes of skin breaks - for example, burns or other types of skin conditions.
What are the symptoms of eczema herpeticum?
A child or person with eczema herpeticum develops a skin rash which looks like lots of little blisters. These are usually in areas where there has been a skin condition (usually atopic eczema). The spots are usually quite sore and sometimes itchy. The spots then spread to other areas of skin. Eczema herpeticum can develop on any part of the body but is most common on the face or neck.
The blisters are all around the same size. They are filled with fluid. It may be a clear fluid or a yellowish fluid called pus. They may bleed or ooze or weep. They then become crusted over. For pictures of the rash, see the images on the DermNet NZ website in References below.
If you have eczema herpeticum, you feel unwell. You may have a high temperature (fever). You may be able to feel lumps called lymph nodes in your neck, armpits or groin. These come up in response to the infection, to help fight it.
How is eczema herpeticum diagnosed?
Usually eczema herpeticum is diagnosed from the typical appearance. Samples (swabs) may be taken from the spots to confirm it.
How is eczema herpeticum treated?
An antiviral medicine such as aciclovir is usually very successful for treating eczema herpeticum. It may be given as a liquid or a tablet. For people who are too unwell to take it as a liquid or a tablet, it can be given through the veins (intravenously).
Sometimes an antibiotic may be needed as well. This is because the damage to the skin makes you more likely to become infected by the bacteria normally harmlessly present on the skin as well. This is called a secondary bacterial infection.
Eczema herpeticum is considered an emergency. This is because it can spread so fast. So it must be treated correctly and quickly. If you or your child are diagnosed with eczema herpeticum you will normally be sent to hospital that day for advice from a specialist. As long as you or your child are able to take medicine by mouth, however, you would not normally have to stay in hospital. You would be given treatment to take home, and then return for check ups.
Is eczema herpeticum infectious (contagious)?
Normally you can't pass on eczema herpeticum from one person to another. However it may be possible to pass it on to some more vulnerable people. So if you or your child have eczema herpeticum it would be sensible to avoid contact with:
- Children with atopic eczema.
- People who have problems with their immune systems (immunosuppression). This would include people with AIDS, people who have recently had chemotherapy or people who are on steroid medication.
- Newborn babies.
What is the outlook (prognosis) for eczema herpeticum?
As long as eczema herpeticum is treated quickly and with the right antiviral medicine, the outlook is very good. The spots usually heal up and go away in 2-6 weeks. If it is not treated quickly, however, it can spread rapidly and may have complications. It can cause damage to eyesight. There may be secondary infections with other germs such as bacteria. Particularly in people whose immune systems are not working well, it may occasionally cause death. This is because it may cause damage to other organs such as the brain, liver or lungs if it spreads.
Usually eczema herpeticum is cured by the antiviral medication. Sometimes eczema herpeticum can come back and need to be treated again.
Further reading & references
- Atopic eczema in children; NICE Clinical Guideline (December 2007)
- Eczema herpeticum; DermNet NZ
- Liaw FY, Huang CF, Hsueh JT, et al; Eczema herpeticum: a medical emergency. Can Fam Physician. 2012 Dec;58(12):1358-61.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Mary Harding
Dr Mary Harding
Dr Hayley Willacy