Eczema Herpeticum: Causes, Symptoms, Diagnosis and Treatment


Eczema herpeticum, also known as Kaposi’s varicelliform eruption, is a potentially serious viral infection that mainly affects people with skin conditions like atopic dermatitis or psoriasis. It is caused by the herpes simplex virus (HSV), most commonly type 1. When a person who already has eczema is exposed to HSV, it can lead to widespread infection of the skin. While rare, eczema herpeticum requires prompt treatment as it can rapidly spread, cause serious complications, and can even be life-threatening in some cases.

Causes of Eczema Herpeticum

Eczema herpeticum occurs when the herpes simplex virus comes into contact with skin affected by eczema or other chronic skin conditions. This compromises the skin’s protective barrier function, allowing the virus to proliferate unchecked. The most common causes include:

  • Atopic dermatitis: This chronic inflammatory skin condition characterized by red, cracked and itchy skin is the main risk factor. Over 90% of cases occur in people with atopic dermatitis.
  • Other eczemas: Nummular, dyshidrotic and hand eczema may also increase susceptibility to eczema herpeticum.
  • Skin trauma: Cuts, abrasions or severe scratching can allow the HSV entry into the skin.
  • Immunosuppression: People on immunosuppressant drugs or with weakened immune systems are at higher risk.
  • Prior HSV infection: Even mild herpes infection like cold sores can put people with eczema at risk.

Symptoms of Eczema Herpeticum

The main symptoms to watch out for include:

  • Groups of small, fluid-filled blisters similar to cold sores.
  • Severe eczema flare up with intense itching, redness and inflammation of the skin.
  • Skin pain, tenderness or burning sensations.
  • Fever, lethargy and swollen lymph nodes.
  • Oozing and crusting of blisters as they rupture.

As the infection rapidly spreads across the body, symptoms get progressively worse. Patients may develop headaches, chills, nausea or diarrhea. In severe cases, eczema herpeticum can affect the eyes, mouth, esophagus or even spread to the brain and other internal organs. Seek emergency care if you experience difficulty breathing, confusion, seizures or slurred speech.

Diagnosis of Eczema Herpeticum

Doctors often diagnose eczema herpeticum based on its distinctive blistering rash and a patient’s history of atopic dermatitis or other skin conditions. However, further testing helps confirm the diagnosis:

  • Viral culture: Fluid from the blisters is sent to the lab to test for HSV. This is the most accurate way to diagnose it.
  • Polymerase chain reaction (PCR) : This looks for HSV DNA in the blister fluid or lesions.
  • Tzanck test: Examining blister cells under the microscope shows multinucleated giant cells indicative of herpes virus infection.
  • Blood tests: These check for elevated white blood cell count due to infection and antibodies specific to HSV.

Ruling out other conditions like impetigo, contact dermatitis or mere eczema flare ups may require biopsy and histopathology.

Treatment for Eczema Herpeticum

Early treatment is crucial to prevent dangerous complications of disseminated HSV infection. It involves:

  • Antiviral medications: Drugs like acyclovir, valacyclovir or famciclovir help control the herpes virus. They are administered orally or intravenously based on severity.
  • Pain medication: Over the counter options like ibuprofen help relieve skin pain. Narcotics may be prescribed for severe pain.
  • Wound care: Gentle cleansing, topical antibiotics and bandaging prevent secondary infections. Avoid bursting blisters.
  • Hospitalization: Severe cases require monitoring and treatment in hospital with antivirals injected directly into the veins.
  • Immunomodulators: These suppress an overactive immune response making eczema worse. Topical tacrolimus or oral cyclosporin may be used short term.

In addition, patients must keep skin moisturized, minimize scratching and avoid triggers that exacerbate eczema. Complete healing and recovery from an episode of eczema herpeticum often takes 2 to 6 weeks.

Preventing Outbreaks

While eczema herpeticum cannot always be prevented, the following measures can reduce risk:

  • Control eczema flares and keep skin well-hydrated. Avoid irritants and allergens.
  • Take prescribed immunosuppressants consistently to maintain remission of atopic dermatitis.
  • Avoid direct skin contact with people who have active cold sores or herpes lesions.
  • Consider prophylactic oral antivirals like acyclovir or valacyclovir during high risk situations.
  • Get the shingles vaccine if over 50 years old. Chickenpox vaccine may help reduce risk in children.
  • Educate family and caregivers on early signs of infection. Seek treatment at first suspicion rather than waiting for confirmation.

Prompt diagnosis and treatment are key to preventing the potentially dangerous complications of eczema herpeticum. Maintaining healthy skin and minimizing eczema flares goes a long way towards reducing the risks associated with this viral infection.


Eczema herpeticum is a serious complication that can arise in people with underlying skin conditions like atopic dermatitis when they are infected with the herpes simplex virus. Watching out for symptoms like blisters and worsening eczema and seeking early medical care is vital to contain the infection before it spreads more extensively. With proper antiviral treatment and good wound care, most cases of eczema herpeticum can be managed successfully. Prevention is equally important, as minimizing skin inflammation and potential viral exposures reduces the chances of eczema herpeticum developing in the first place.

Leave a comment