Eczema herpeticum

Last Updated: 2020-11-19

Author(s): Anzengruber, Navarini

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
  1. Bommer, S. and G. Wolfram, [Observations on eczema herpeticatum and eczema vaccinatum]. Dtsch Gesundheitsw, 1954. 9(24): p. 747-50.
  2. Bohm, C. and H.O. Johne, [Case reports on eczema herpeticatum (herpetiforme) Kaposi]. Hautarzt, 1956. 7(5): p. 213-6.
  3. Kriegk, H.J., [Eczema herpeticatum in the adult]. Dermatol Wochenschr, 1952. 125(2): p. 25-9.
  4. Nasemann, T. and U. Schnyder, [Virological diagnosis of Kaposi's eczema herpeticatum (herpetiforme)]. Hautarzt, 1957. 8(12): p. 549-52.
  5. Teller, H., [Recurrent eczema herpeticatum]. Dermatol Wochenschr, 1955. 132(43): p. 1130-3.
  6. Hiemisch, I., [Cure of a widespread eczema herpeticatum in generalized neurodermatitis with Gamma-Venin]. Hautarzt, 1970. 21(11): p. 516.
  7. Peter, H., [Differential diagnosis & therapy of eczema herpeticatum]. Klin Med Osterr Z Wiss Prakt Med, 1958. 13(2): p. 60-70.
  8. Herzberg, J.J. and G. Pliess, [Eczema herpeticatum with fatal course]. Frankf Z Pathol, 1955. 66(4): p. 330-47.
  9. Braun-Falco, O. and P. Bilek, [Pyoderma gangrenosum, trichopytosis superficialis, eczema herpeticatum, lupus vulgaris, acne urticaria, hypertrichosis faciei due to glucocorticoids, malignant reticulosis, dyskeratosis follicularis]. Hautarzt, 1973. 24(8): p. 359-60.
  10. Maneke, M., [Eczema herpeticatum in children; pustulosis vacciniformis acuta; Kaposi's verricelliform eruption]. Monatsschr Kinderheilkd, 1954. 102(5): p. 258-62.
  11. Wetzel, S. and A. Wollenberg, [Eczema herpeticatum]. Hautarzt, 2004. 55(7): p. 646-52.
  12. Korting, G.W., H. Krautheim, and W. Wieland, [Eczema herpeticatum]. Med Welt, 1983. 34(21): p. 611-3.