Eczema herpeticatum

Last Updated: 2022-03-11

Author(s): Anzengruber F., Navarini A.

ICD11: 1F00.03

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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