eczema herpeticum

Eczema HerpeticumEczema Herpeticum

Sarah GoodallSarah Goodall

ObjectivesObjectives IntroductionIntroduction AetiologyAetiology Clinical PresentationClinical Presentation DiagnosisDiagnosis TreatmentTreatment ConclusionConclusion

IntroductionIntroduction Described by Kaposi in 1887Described by Kaposi in 1887 Herpetic super-infection of pre-Herpetic super-infection of pre-

existing skin diseaseexisting skin disease HSV-1 or HSV-2HSV-1 or HSV-2 Potentially life-threateningPotentially life-threatening

Eczema HerpeticumEczema Herpeticum

AetiologyAetiology1.1. Auto-inoculationAuto-inoculation2.2. Infectious contactInfectious contact

Disruption of stratum corneumDisruption of stratum corneum Recent trauma (e.g. burns)Recent trauma (e.g. burns) Auto-grafted skinAuto-grafted skin Post dermabrasionPost dermabrasion } Disruption

of

integrity of

the epidermis

Immunosuppression – (medication)Immunosuppression – (medication) Precipitating factors of HSVPrecipitating factors of HSV

Reports of Eczema Herpeticum:Reports of Eczema Herpeticum:Atopic dermatitisAtopic dermatitisPemphigus vulgarisPemphigus vulgarisSeborrheic dermatitisSeborrheic dermatitisWiskott Aldrich syndrome Wiskott Aldrich syndrome Etc….Etc….

Clinical PresentationClinical Presentation

Multiple clusters of vesiclesMultiple clusters of vesicles Vesicles spread Haemorrhagic Vesicles spread Haemorrhagic

& crusted& crusted Painful punched out erosionsPainful punched out erosions FeverFever Malaise/systemically unwellMalaise/systemically unwell

Differential DiagnosisDifferential Diagnosis Exacerbation of primary skin lesionExacerbation of primary skin lesion Animal Pox VirusAnimal Pox Virus Blistering diseaseBlistering disease

-e.g. pemphigus vulgaris-e.g. pemphigus vulgaris- bullous pemphigoid- bullous pemphigoid

DiagnosisDiagnosis Punched out erosions Punched out erosions Fever and extreme painFever and extreme pain Tzanck preparationTzanck preparation Direct fluorescent antibody Direct fluorescent antibody Viral cultureViral culture

TreatmentTreatment Acyclovir – IV 15mg/kg/day (5-10 days)Acyclovir – IV 15mg/kg/day (5-10 days)Oral 400mg 5x day 5-10 daysOral 400mg 5x day 5-10 days

PainPain

Bacterial super-infection Bacterial super-infection

ProphylaxisProphylaxis

Why is it a dermatologicalWhy is it a dermatologicalEmergency?Emergency?

Life threatening!Life threatening!

Herpes keratitisHerpes keratitis

Herpes keratitisHerpes keratitis Western world - commonest cause of Western world - commonest cause of

corneal blindnesscorneal blindness Pain, photophobia, blurred vision, Pain, photophobia, blurred vision,

tears, rednesstears, redness Infectious – corneal vesicles, Infectious – corneal vesicles,

dendritic ulcers, geographical ulcersdendritic ulcers, geographical ulcers Consider corneal transplantConsider corneal transplant

ConclusionConclusion Herpetic super-infection of pre-existing Herpetic super-infection of pre-existing

skin diseaseskin disease

Potentially life-threateningPotentially life-threatening

Early recognition vitalEarly recognition vital

Effective treatmentEffective treatment

Pre-existing skin diseasePre-existing skin diseaseand and

Acute Blistering?Acute Blistering?

ThinkThinkEczema HerpeticumEczema Herpeticum

ReferencesReferences Mackley C, Adams DR, Anderson B, Miller JJ. Eczema Mackley C, Adams DR, Anderson B, Miller JJ. Eczema

herpeticum: a dermatological emergency herpeticum: a dermatological emergency Dermatology NursingDermatology Nursing Oct 2002;14(5):307-10 Oct 2002;14(5):307-10

Wollenberg A, Zoch C et al. Predisposing factors and clinical Wollenberg A, Zoch C et al. Predisposing factors and clinical features of eczema herpeticum: a retrospective analysis of 100 features of eczema herpeticum: a retrospective analysis of 100 cases cases Journal of the American Academy of Dermatology Journal of the American Academy of Dermatology Aug Aug 2003;49(2):198-2052003;49(2):198-205

Buccolo LS. Severe rash after dermatitis Buccolo LS. Severe rash after dermatitis The Journal of Family The Journal of Family Practice Practice Aug 2004;53(8):Aug 2004;53(8):

Atherton DJ, Marshall WC. Eczema herpeticum. Atherton DJ, Marshall WC. Eczema herpeticum. PractitionerPractitioner 1982;226:971–973.1982;226:971–973.

Simon C, Everitt H, Kendrick T. Simon C, Everitt H, Kendrick T. Oxford Handbook of General Oxford Handbook of General Practice Practice 2nd ed. Oxford: Oxford University Press, 2005 2nd ed. Oxford: Oxford University Press, 2005