Eczema Herpeticum With Atopic Dermatitis
A 15-month-old girl with a history of poorly controlled atopic dermatitis presented with erythema and scattered lesions around her right eye. Four days before presentation, the child was noted to have 2 small macules near the eye, which her foster mother attributed to an eczema flare-up. Over the ensuing 4 days, the eyelid became progressively erythematous, and the number of lesions increased. The lesions were associated with some eyelid swelling and scant yellowish discharge. There were no reported fevers, cough, nasal congestion, ear tugging, or change in appetite.
On physical examination, the patient was afebrile, with a temperature of 37.2°C. She exhibited apprehension during the examination, typical of patients her age, but she was easily consolable by her foster mother.
The girl had a number of grouped vesicular lesions on the right upper and lower eyelids. Some vesicles had crusted over. An open lesion was present on the right upper eyelid. There were no apparent lesions on the surface of the sclera or cornea, and there was no scleral injection. There was no photophobia. A minimal amount of dried, yellow drainage was observed on the right medial canthus. There were no lesions or erythema around the left eye. Extraocular muscles were intact bilaterally. Her pupils were equal and reactive to light bilaterally.
The child had one of the lesions unroofed, and subsequent viral polymerase chain reaction test results were positive for herpes simplex virus DNA.
She received a diagnosis of eczema herpeticum and was treated with a regimen of oral acyclovir.
She was urgently evaluated by an ophthalmologist, who found no involvement of the globe. The girl had close outpatient follow-up and recovered without incident.
Eczema herpeticum is a herpes simplex virus infection of inflamed skin that most often occurs in children with underlying atopic dermatitis. Patients with the condition may present with an eruption of vesicles, sometimes disseminated in nature, which may be accompanied by fever, malaise, and lymphadenopathy. The head and neck are the most commonly involved areas on the body. The typical evolution from vesicle eruption to crusting to resolution is 2 to 6 weeks.
The treatment of choice is acyclovir along with prevention of superimposed bacterial infection. If left untreated, eczema herpeticum is potentially life threatening and can result in systemic viremia.