Tuesday, December 1, 2015

AN ACUTE MONOMORPHIC ERUPTION IN A SYSTEMICALLY UNWELL ATOPIC CHILD

DIAGNOSIS ?

 typical lesions of herpes simplex virus (HSV)
 typical lesions of herpes simplex virus (HSV)

These are typical lesions of herpes simplex virus (HSV) infection complicating atopic
eczema. This eruption is called eczema herpeticum, or less commonly Kaposi’s varicelliform
eruption.

Diagnosis can be confirmed by viral swab of a blister or eroded area. Many tests can
detect HSV within tissue or blister fluid. HSV can be inferred by positive staining or
electron microscopy or specifically identified as types HSV-1 or HSV-2 by immunofluorescence,
culture, or polymerase chain reaction. Bacteriology swab for microscopy and
culture should also be undertaken.

Significant morbidity is associated with eczema herpeticum. The main potential complications
include superimposed bacterial infection (Staphylococcus or Streptococcus)
with risk of systemic sepsis, ocular involvement (in particular, HSV keratitis) and, rarely,
systemic HSV infection with risk of spread to the liver, the lungs, the brain, the gastrointestinal
tract and even the adrenal glands. In addition pain and discomfort associated
with eczema herpeticum is significant.


The management of widespread eczema herpeticum includes systemic treatment of HSV
infection with aciclovir, identification and treatment of any superimposed bacterial
infection or strategies to prevent superimposed infection, such as antibacterial washes
and creams. Topical tacrolimus should be discontinued in this patient as this may exacerbate
the cutaneous spread of HSV. These cases are usually managed as in-patients,
initially with intravenous aciclovir – as oral preparations can be poorly absorbed.

Ophthamological review should be sought in cases of diffuse facial herpes simplex infection
or where conjunctival/corneal involvement is suspected.


In a minority of cases recurrences can occur. Rapid treatment of incipient lesions with
topical aciclovir may help prevent disseminated eczema herpeticum.

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