Eczema Herpeticum

Eczema herpeticum (EH) is a viral skin infection that causes small, sometimes painful blisters that can spread over large areas. Most cases occur when someone who has atopic dermatitis (a type of eczema) gets infected with or reactivates the herpes simplex virus (HSV). HSV is the virus that causes cold sores.

Eczema herpeticum (pronounced "EK-suh-muh her-PET-ik-uhm") affects between 3% and 6% of people who have atopic dermatitis. If you have a healthy immune system, EH may be mild. But if you have a severe infection or a weakened immune system, EH can be serious if it spreads to your eyes or a vital organ.

If you have EH symptoms, you should see your healthcare provider quickly. Without a proper diagnosis and treatment, the infection can get worse and require hospitalization. Severe cases can even be life-threatening.

Another name for EH is Kaposi varicelliform eruption.

What does eczema herpeticum look like?

The initial symptom may be a cold sore. But in a lot of cases, eczema herpeticum starts with a blistering rash that develops over a week or a week and a half. It usually spreads over patches of skin that are affected by atopic dermatitis. The blisters may be itchy, tingly or painful.

Blisters may appear anywhere on your body. But they’re most likely to occur on your face, neck or torso. They’re usually all the same size and contain clear fluid. The fluid may look cloudy or yellow if you have a secondary infection. This happens when bacteria infect the blistered skin.

Over the next week or two, the blisters usually break open. They may bleed, and fluid may leak out (weep). Once they dry out, they may look crusty and develop into sores.

In addition to a blistering rash, you may have symptoms like:

• Fever
• Chills
• Headache
• Swollen lymph nodes
• Feeling unwell (malaise)

Causes

Herpes simplex virus type 1 (HSV-1) causes most cases of eczema herpeticum. But herpes simplex virus type 2 (HSV-2) can also cause it.

EH symptoms usually appear five to 12 days after getting HSV from an infected person or from reactivation of the virus.

Risk factors

Anyone of any age can get eczema herpeticum. But those at a greater risk of getting it include:

• Infants and children with atopic dermatitis
• People who have a weakened immune system
• People with atopic dermatitis who have breaks on their skin or who get cosmetic procedures, like dermabrasion or a chemical peel

Complications

Healthcare providers consider eczema herpeticum a medical emergency because it can sometimes have serious and even life-threatening complications.

If EH spreads to your eyes, it can result in vision loss and even total blindness.

In rare cases, the virus may spread to your brain, lung and liver. If a vital organ stops working or if you develop a secondary bacterial infection in your blood, it can be fatal without treatment.

How doctors diagnose eczema herpeticum

Your healthcare provider first reviews your health history and asks about your symptoms. They can usually recognize eczema herpeticum after conducting a physical exam.

To confirm the diagnosis, they may wipe a blister with a cotton swab and send it to a lab to check for HSV. They may also check the sample for bacteria if you have signs of a bacterial infection.

How is eczema herpeticum treated?

Your healthcare provider will give you an antiviral medication, like acyclovir or valacyclovir. You may take this as a syrup you drink or a pill you swallow. In severe cases, you may get an IV infusion directly into a vein. 

Be sure to take your medication exactly as directed. If you don’t, the infection may come back or get worse.

If you have a secondary bacterial infection, your provider may also prescribe antibiotics.

If EH affects your eyes, your provider will refer you to an eye doctor (ophthalmologist).

Recovery time

Blisters should start to heal around two to four weeks after treatment. Your healthcare provider will explain when you can expect any other symptoms to go away.

When should I see my healthcare provider?

If you have atopic dermatitis or any other condition that causes skin inflammation, call your healthcare provider as soon as you notice blisters on your skin. Get help right away if you have blisters near your eyes or your symptoms get worse quickly. Your provider may refer you to an eye specialist immediately.

What can I expect if I have eczema herpeticum?

It’s a serious, potentially life-threatening condition. But the sooner you see a healthcare provider and get a diagnosis, the better your outlook. Antiviral medications greatly increase the chances of making a full recovery.

Eczema herpeticum may come back, even after successful treatment. But this is rare. If it does come back, symptoms are usually milder.

Can eczema herpeticum be prevented?

If you have atopic dermatitis, the best way to prevent EH is to avoid exposure to the herpes simplex virus or avoid reactivation of the virus. Here are some ways you can help lower your risk:

• Avoid close contact and sharing items with people who have cold sores.
• Wash your hands with clean water and soap after touching a sore.
• Avoid sexual contact if your partner has genital sores. Keep in mind that condoms may not cover all sores, so you may still get the virus.
• Keep your atopic dermatitis well-managed, as a healthy skin barrier lowers your risk.