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Eczema Herpeticum

There are two conditions which when combined can cause a complication which, although rare, can be dangerous. It is known as eczema herpeticum. Of the two conditions that cause this life threatening illness, one condition is eczema and the other is herpes.

Eczema causes dry, itchy skin rashes and although eczema results in considerable discomfort, it is not life threatening. Different types of eczema include atopical dermatitis, discoid, nummular and contact dermatitis.Herpes is caused by the herpes simplex virus types 1 and 2 and can lead to cold sores around the mouth or genital herpes.  Although it can be very painful and include flu-like symptoms, an outbreak of herpes will eventually resolve itself and will not be dangerous.

The problem arises when the two conditions combine and you get eczema herpeticum. Unless very mild, this condition is considered to be a medical emergency because of the risk of superinfection.  The complication can occur in male or female at any age and, although it usually lasts for approximately 16 days, it can continue for several weeks.

Eczema Herpeticum will first appear as a rash with clusters of small blisters. These blisters will often have a characteristic dome with an indentation.  A fever and flu-like symptoms also occur with the rash either remaining in the same area as the pre-existing eczema or spreading over the entire body.  Apart from pain, you may be aware of light sensitivity. As the condition worsens, the blisters become filled with pus before developing a crust and starting to bleed, similar to impetigo..

There is an additional risk if the infection spreads to the eyes. The risk of super infection is high if the rash spreads. A resistant strain of a bacterial infection will be very difficult to treat. Unfortunately, treatment is not always carried out soon enough because the initial condition of eczema can mask the new symptoms.  Sometimes the condition is even confused with shingles.

Because it is important to control the illness as quickly as possible, acyclovir may be prescribed as soon as eczema herpeticum is suspected, even before it is confirmed by laboratory results. Acyclovir is often used by doctors to treat herpes outbreaks. If the condition seems mild, oral acyclovir may be prescribed but in more serious infections, IV administration is normal.  Antibiotics will also be prescribed as a preventative measure because of the risk of superinfection.  Testing is carried out by taking viral cultures of the fluid from the blisters, and possibly a biopsy of a small piece of the infected skin..

Remember that if you already suffer from eczema with open rashes and you come into skin contact with someone who has a herpes cold sore or fever blister, you can get this condition known as eczema herpeticum and you would need to seek urgent medical attention.  Despite the availability of antiviral therapies, eczema herpeticum is still a dangerous condition and often requires emergency treatment.  Be aware that even after the condition has been treated, the skin remains sensitive and will often need special care.



Further Reading: Nummular Eczema, Dyshidrotic Eczema

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