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admin 14.01.2016

One week earlier, a 14-month-old girl with a history of eczema was evaluated because of a diffuse rash of excoriated lesions, some of them purulent.
A 10-year-old boy is brought by his mother for evaluation of persistent “acne” that started when the boy was a baby. Before the advent of antiviral drugs, the associated mortality rate ranged from 1% to 9%.1 Eczema herpeticum is acquired through autoinoculation in a latent host or from an infected contact.
The vesiculopustules progress to painful hemorrhagic, crusted, punched-out erosions that coalesce into denuded areas.2 These findings help distinguish worsening eczema from eczema herpeticum.

Eczema herpeticum may be misdiagnosed as an exacerbation of underlying atopic dermatitis and subsequently treated with higher-dose corticosteroids, which can lead to serious consequences.Diagnosis is mainly clinical. The Tzanck test provides the fastest test result but is neither sensitive nor specific for HSV infection.4 Direct fluorescent antibody staining is rapid and accurate, although not as sensitive as culture. Viral culture, while both sensitive and specific for HSV infection, requires at least 48 hours for results.2Acyclovir is the mainstay of treatment. Topical antibiotic cream is recommended for all patients to prevent secondary bacterial infection.

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