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Posted by on Saturday, January 29, 2011, 1:05
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Eczema herpeticum, initially described by Kaposi in 1887, is a potentially life-threatening herpetic super infection of a pre-existing skin disease. Eczema Herpeticum occurs as a result of the eczema being infected with the herpes simplex virus, the virus that produces cold sores. It is important to avoid skin contact with anyone who has cold sores.


Normally, herpes simplex will be confined to cold sores around the mouth and is a routine condition. However, in a person with eczema the virus can appear anywhere on the skin. In rare cases, it can prove fatal. Despite the availability of antiviral therapies, eczema herpeticum remains a dermatological emergency today.

Eczema herpeticum appears in small clusters and looks like blisters or ulcers. These are initially filled with a clear fluid but this turns to pus. The blisters are scratched and become raw and weepy. The symptoms of eczema herpeticum may include a high temperature; an extensive rash with small skin blisters filled with yellow pus and you may generally feel unwell. The rash can cover the whole of the skin surface. Eczema herpeticum can occur when anyone with eczema, especially if it is sore and open has skin-to-skin contact with someone who has active facial (cold sores) or genital herpes. The cause of eczema herpeticum is always HSV type I. The exact patho-physiology is unknown, but it is thought to involve HSV entering the skin when skin barrier function is compromised due to dermatitis. Defective cytokine secretion in the affected skin also plays an important role. The severity of preexisting eczema does not seem to dictate the severity of eczema herpeticum. Secondary bacterial skin infections are very common. A mixture of aerobic and anaerobic bacteria are commonly isolated, the most common being S aureus, Group A ß-hemolytic Streptococcus, Pseudomonas, and Peptostreptococcus.

If your eczema becomes worse for no apparent reason or you see blisters on the surface, medical advice is required. With eczema herpeticum the sufferer may have a high temperature and feel very ill. Be sure to explain all your symptoms to your doctor because this is not a straightforward condition to diagnose.

The first indication of infection occurs 5 to 12 days after exposure to the virus and typically appears as multiple itchy, watery blisters that occur on skin previously affected by atopic dermatitis. If these blisters are not treated, they can become progressively worse as illustrated by these four stages of Eczema herpeticum: In stage one, multiple itchy, watery blisters over an area of skin, usually where atopic dermatitis lesions were present (5 to 12 days after exposure). Stage two begins as the blisters begin to disseminate or “crop” into adjacent areas of skin. In stage three, the blisters may bleed, become encrusted, and erode – at this stage the condition becomes extremely painful. At stage four, the viral infection spreads to cover the entire body, with associated fever and swollen lymph nodes. Secondary bacterial infection frequently develops in large, eroded areas of skin.

During all stages, fever is usually present and the person feels ill. The first episode of eczema herpeticum usually runs its course in 2 to 6 weeks if left untreated. However, letting the disease run its course is not recommended as eczema herpeticum can be life threatening. Subsequent outbreaks tend to be milder, unless the patient has an underlying immunodeficiency condition.

With Eczema herpeticum hospital treatment may be required. This type of infected eczema is usually treated with an anti-viral drug acyclovir, which is given by injection, by mouth or as an ointment.

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