Eczema herpeticatum

Kaposi 1887, Juliusberg 1898.

Eccema herpetiformis, Eccema herpetiforme Kaposi, Pustulosis acuta varioliformis Juliusberg, Pustulosis acuta varicelliformis.

Super-infection with HSV I in atopic eczema, lymphoma, Grover's disease, Darier's disease, Hailey-Hailey disease, pemphigus foliaceus, erythrodermic psoriasis, pityriasis rubra pilaris or therapy with steroid-containing topical agents and vemurafenib. Some patients go through multiple episodes of the disease.

• Transmission
• Frequently after herpes labialis (autoinoculation) or through contact with infected persons

In the area of the skin that has been damaged by the underlying disease, pain, a feeling of tension, erosions and rarely herpes blisters, reduced AZ, fever, headache, lymphadenopathy.

• Clinical
• Immunofluorescence (Microtrak)
• Possibly viral PCR from a blister
• If necessary, exclude meningismus
• If necessary, ophthalmological consultation
• If necessary, neurological consultation

Whole body, most commonly affecting the neck area.

• Edema of the eyelid
• Bronchopneumonia
• Aseptic meningitis and encephalitis
• Keratitis herpetica

• No systemic cortisone therapy (CAVE: herpes sepsis).

Systemic therapy:

• Aciclovir
  • Administration: at 3x 5mg/kg bw/d i.v. or 5x 200 mg/d p.o., at 10mg/kg bw/d i.v.
  • in case of immunosuppression
  • KI: Hypersensitivity, lactation.
  • SNW (very common): headache.
  • CAVE:
    • In elderly patients, there is an increased risk for the occurrence of reversible neurological disorders.
    • Adjust dosage if renal function is impaired.
    • Enough fluid intake.
• If necessary, paracetamol (fever).
• If necessary, antibiotic therapy with e.g.:

• Cephalosporins
  • Cefuroxime p.o. 500 mg 2x daily
  • Cefuroxime in secondary impetiginisation (often staphylococci) to prevent bronchopneumonia.
  • Administer: 1 g. p.o. 2× daily for 5-10 days.
  • CI: Hypersensitivity, lactation.
  • CAVE:
    • Kidney function.
    • Accomplish adequate hydration, control electrolytes.

Topical therapy:

• Lotio alba several times a day
• Zinc shake concoctions
• Antiseptic externals

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