Eczema Herpeticum: Kaposi Varicelliform Eruption…

Patients with atopic dermatitis (AD) are susceptible to cutaneous dissemination of the herpes virus, referred to as Eczema Herpeticum (EH) and/or Kaposi Varicelliform Eruption.  Development of EH has been shown to be associated with severe AD, higher IgE levels, elevated eosinophil counts, food and environmental allergies and onset of AD before the age of 5.  Cutaneous dissemination of herpes virus type 1 (HSV-1) and herpes virus type 2 (HSV-2) has also been reported in patients with severe seoborrheic dermatitis, generalized scabies, Darier’s disease, benign familial pemphigus, pemphigus (foliaceus or vulgaris), pemphigoid, Sezary syndrome, cutaneous T-cell lymphoma, Wiskott-Aldrich syndrome, allergic and photoallergic contact dermatitis and burns.

In its severest form hundreds of umbilicated vesicles erupt and may be associated with fever and regional adenopathy.  The cutaneous eruption is alarming but luckily the disease is often self-limiting in healthy individuals.  Milder cases are considerably more common and may go unrecognized and untreated in some patients.  The most frequently affected areas include the trunk, neck and head.  Lethal cases have been reported.

ETIOLOGY:  As mentioned, disseminated cutaneous herpes infection is the cause in susceptible patients.  The diagnosis is often based on clinical grounds.  Additional investigations will confirm the diagnosis, such as Tzanck prep (see below), histology and DNA polymerase chain reaction.

TREATMENT:  The differential diagnosis includes Chickenpox, impetigo and allergic contact dermatitis.  Immediate implementation of an herpes simplex virus (HSV) antiviral, such as Valtrex or Famvir should be administered.  To read more about EH click HERE, HERE and HERE.