A 2-year-old boy was brought for evaluation of a rash and fever of 2 days' duration. He had atopic dermatitis since 6 months of age that was partially controlled with low-potency topical corticosteroids and emollients. His father reported that recently the facial dermatitis had worsened, with increased redness, pain, and some skin breakdown. The child's medical history was otherwise unremarkable. His mother had a history of ;cold sores.;
The patient was irritable during the examination; temperature was 40°C (104°F).He had scaly, erythematous patches on the extensor surfaces of all extremities. Lichenified plaques were present on the wrists and ankles. There were multiple monomorphic, 3- to 4-mm, umbilicated, crusted vesicopustules with erythema on the face, particularly on the forehead above the right eye (Figure 1).
No conjunctiva involvement or ocular symptoms were noted.
The history and clinical features are typical of eczema herpeticum. A Tzanck smear of a specimen taken from the base of involved vesicles revealed multinucleated giant cells, con- sistent with herpesvirus (Figure 2).
The patient was treated with oral acyclovir, 400 mg tid for 7 days. In addition, cephalexin, 250 mg tid for 7 days, was given because of a suspected secondary Staphylococcus aureus infection, indicated by the yellow crusting. At follow-up, the lesions and fever had resolved.
ECZEMA HERPETICUM: CAUSE AND PREVALENCE
Atopic dermatitis, which affects between 12% and 26% of children in the United States, has become increasingly common over the past 30 years.1 Superimposed viral infection is an uncommon complication of atopic dermatitis. Atopic patients are prone to opportunistic infection because their skin barrier is compromised and their immune response may be suppressed.
Kaposi varicelliform eruption refers to a cutaneous herpes simplex virus (HSV) infection in patients with a preexisting dermatosis.1 Eczema herpeticum represents HSV infection in the setting of atopic dermatitis.2 Eczema herpeticum can be caused by either type 1 or type 2 HSV.
Epidemiologic data on eczema herpeticum are scarce; however, there has been an increase in the number of patients treated for the condition in university hospitals in recent years.3 Eczema herpeticum may be associated with an early onset of atopic dermatitis and a high total serum IgE level.2
1. Mooney MA, Janniger CK, Schwartz RA. Kaposi's varicelliform eruption. Cutis. 1994;53:243-245.
2. Wollenberg A, Wetzel S, Burgdorf WH, Haas J. Viral infections in atopic dermatitis: pathogenic aspects and clinical management. J Allergy Clin Immunol. 2003;112:667-674.
3. Wollenberg A, Zoch C, Wetzel S, et al. Predispoing factors and clinical features of eczema herpeti-
cum: a retrospective analysis of 100 cases. J Am Acad Dermatol. 2003;49:198-205.
4. Katta R. Painful skin erosions and fever in an infant. Eczema herpeticum. Postgrad Med. 2001;109: 129-130.
5. Mackley CL, Adams DR, Anderson B, Miller JJ. Eczema herpeticum: a dermatologic emergency. Dermatol Nurs. 2002;14:307-310.