a.k.a Kaposi varicelliform eruption
Eczema herpeticum describes a severe primary infection of the skin by herpes simplex virus 1 or 2.
It is more commonly seen in children with atopic eczema and often presents as a rapidly progressing painful rash.
This image shows a child with widespread monomorphic vesiculopustular and erosive lesions on the cheeks, perioral area, and chin, many with haemorrhagic crusting. The lesions are punched-out, confluent in areas, and set on a background of erythema, consistent with eczema herpeticum—a disseminated herpes simplex virus (HSV) infection typically superimposed on atopic dermatitis. The distribution around the mouth and lower face is characteristic.
On examination,
monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1-3 mm in diameter are typically seen.
As it is potentially life-threatening children should be admitted for IV aciclovir.
a potential complication of severe atopic dermatitis
Superinfection with herpes simplex virus can cause a vesicular eruption on preexisting inflamed skin
may appear as punched-out ulcers within and spreading outward from skin damaged by the predisposing burn or dermatitis
can have pain and fever
commonly associated with a parent with recurrent herpes labialis (HSV-1)
This condition is associated with preexisting skin conditions, most often with atopic dermatitis. Pruritus and dry skin in the flexural folds are core symptoms of atopic dermatitis and are thus very likely to be present in this patient.
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Eczema herpeticum is considered a dermatological emergency and systemic dissemination of HSV can occur in immunocompromised hosts so early treatment with systemic antiviral agents (acyclovir, valacyclovir) is essential