Emergent Care / Stabilization:
Eczema herpeticum is a medical emergency in neonates, infants, and children, and early treatment with antiviral therapy is required.

Eczema herpeticum is rare during the neonatal period. If HSV infection develops during the first week of life, the diagnosis of neonatal herpes simplex virus should be considered.

Diagnosis Overview:
Eczema herpeticum, or Kaposi varicelliform eruption, is a superficial, widespread, cutaneous infection with herpes simplex virus (HSV) 1 or 2 in a patient with atopic eczema. The herpes infection may be primary and sustained from a close contact, or it may occur via autoinoculation. Vesicles, pustules, and characteristic "punched-out" erosions with hemorrhagic crust appear superimposed on areas of preexisting skin disease. Presentation ranges from mild and transient to life-threatening. It mostly affects children but can occur in any age group.

Patients can develop numerous vesicles that may appear in successive crops for several days. Associated systemic symptoms can include high fevers, lymphadenopathy, and malaise. The primary infection is usually more severe than recurrent episodes.

Whereas in healthy adult patients, mild cases can be self-limiting, in children and young infants, this condition is a medical emergency, and early treatment with antiviral therapy is required.

Risk factors that have been proposed for the development of eczema herpeticum include mutations in filaggrin and deficiency of cathelicidins, skin antimicrobial peptides, in the skin. Severe atopic dermatitis and asthma are considered risk factors for the development of eczema herpeticum.

Complications of eczema herpeticum include secondary bacterial infection and multiorgan involvement, including keratoconjunctivitis, meningitis, and encephalitis. Commonly implicated pathogens in bacterial superinfection include Staphylococcus aureus and Streptococcus pyogenes. Systemic viremia can result in serious morbidity and mortality, especially in infants.

Disseminated HSV infection (Kaposi varicelliform eruption) is also reported in cases of Darier disease, autoimmune bullous dermatoses, burns, mycosis fungoides, pityriasis rubra pilaris, and other forms of dermatitis such as irritant contact and seborrheic dermatitis.

Education regarding the chronic nature of herpetic infections is essential, as treatment results in remission rather than true cure, unlike bacterial infections, for example. See Management Pearls for information on avoidance and early intervention.