Eczema herpeticum

Last Updated: 2020-11-19

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Kaposi 1887, Juliusberg 1898.

Kaposi varicelliform eruption, Pustulosis varioliformis acute and Kaposi-Juliusberg dermatitis.

Super-infection with HSV I in atopic eczema, lymphoma, M. Grover, M. Darier, Hailey-Hailey, Pemphigus foliaceus, erythrodermic psoriasis, pityriasis rubra pilaris or therapy with steroid-containing externa and vemurafenib. Some patients experience several phases of the disease.

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

 

Pain, tightness, erosions and rarely herpes blisters, reduced AZ, fever, headaches, lymphadenopathy in the area of the skin pre-damaged by the underlying disease.

  • Clinic
  • Immediate test can make sense here: Immunofluorescence (Microtrak)
  • Virus culture, viral PCR
  • Biopsy if necessary
  • EM if necessary
  • If necessary viral culture
  • Exclude meningism if necessary

 

  • If necessary ophthalmologic consil
  • If necessary neurological consil 

The whole body, most often the neck area is affected.

  • Eyelid edemas
  • Bronchial pneumonia
  • Aseptic meningitis and encephalitis
  • Keratitis herpetica
  • No systemic cortisone therapy (CAVE: herpespsis).

 

Systemic Therapy

  • acyclovir (Zovirax®)
  • Application: at 3x 5mg/kg bw/d intravenously or 5x 200 mg/d p.o., with immunosuppression 10mg/kg bw/d intravenously.
  • CI: Hypersensitivity, lactation.
  • Side effects (very common): Headache.
  • CAVE:
  • In older patients there is an increased risk of reversible neurological disorders.
  • Adjustment of dosage for reduced kidney function.
  • Sufficient liquid supply.
  • If necessary paracetamol (fever).
  • If necessary antibiotic therapy with e.g:

 

  • cephalosporins
  • Cefuroxim p.o. 500 mg 2x daily
  • Cefuroxime in secondary impetiginization (often staphylococcus) to prevent bronchopneumonia.
  • Application: 2× daily 1 g. p.o. for 5-10 days.
  • CI: Hypersensitivity, lactation.
  • CAVE:
  • Kidney function.
  • Sufficient fluid intake, control of electrolytes.

 

Topical Therapy

  • Lotio alba several times a day
  • Zinc shake mixtures.
  • Antiseptic Exteriors
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