Eczema Herpeticum
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Transcript of Eczema Herpeticum
Eczema HerpeticumEczema Herpeticum
Sarah GoodallSarah Goodall
ObjectivesObjectives IntroductionIntroduction AetiologyAetiology Clinical PresentationClinical Presentation DiagnosisDiagnosis TreatmentTreatment ConclusionConclusion
IntroductionIntroduction Described by Kaposi in 1887Described by Kaposi in 1887 Herpetic super-infection of pre-Herpetic super-infection of pre-
existing skin diseaseexisting skin disease HSV-1 or HSV-2HSV-1 or HSV-2 Potentially life-threateningPotentially life-threatening
Eczema HerpeticumEczema Herpeticum
AetiologyAetiology1.1. Auto-inoculationAuto-inoculation2.2. Infectious contactInfectious contact
Disruption of stratum corneumDisruption of stratum corneum Recent trauma (e.g. burns)Recent trauma (e.g. burns) Auto-grafted skinAuto-grafted skin Post dermabrasionPost dermabrasion } Disruption
of
integrity of
the epidermis
Immunosuppression – (medication)Immunosuppression – (medication) Precipitating factors of HSVPrecipitating factors of HSV
Reports of Eczema Herpeticum:Reports of Eczema Herpeticum:Atopic dermatitisAtopic dermatitisPemphigus vulgarisPemphigus vulgarisSeborrheic dermatitisSeborrheic dermatitisWiskott Aldrich syndrome Wiskott Aldrich syndrome Etc….Etc….
Clinical PresentationClinical Presentation
Multiple clusters of vesiclesMultiple clusters of vesicles Vesicles spread Haemorrhagic Vesicles spread Haemorrhagic
& crusted& crusted Painful punched out erosionsPainful punched out erosions FeverFever Malaise/systemically unwellMalaise/systemically unwell
Differential DiagnosisDifferential Diagnosis Exacerbation of primary skin lesionExacerbation of primary skin lesion Animal Pox VirusAnimal Pox Virus Blistering diseaseBlistering disease
-e.g. pemphigus vulgaris-e.g. pemphigus vulgaris- bullous pemphigoid- bullous pemphigoid
DiagnosisDiagnosis Punched out erosions Punched out erosions Fever and extreme painFever and extreme pain Tzanck preparationTzanck preparation Direct fluorescent antibody Direct fluorescent antibody Viral cultureViral culture
TreatmentTreatment Acyclovir – IV 15mg/kg/day (5-10 days)Acyclovir – IV 15mg/kg/day (5-10 days)Oral 400mg 5x day 5-10 daysOral 400mg 5x day 5-10 days
PainPain
Bacterial super-infection Bacterial super-infection
ProphylaxisProphylaxis
Why is it a dermatologicalWhy is it a dermatologicalEmergency?Emergency?
Life threatening!Life threatening!
Herpes keratitisHerpes keratitis
Herpes keratitisHerpes keratitis Western world - commonest cause of Western world - commonest cause of
corneal blindnesscorneal blindness Pain, photophobia, blurred vision, Pain, photophobia, blurred vision,
tears, rednesstears, redness Infectious – corneal vesicles, Infectious – corneal vesicles,
dendritic ulcers, geographical ulcersdendritic ulcers, geographical ulcers Consider corneal transplantConsider corneal transplant
ConclusionConclusion Herpetic super-infection of pre-existing Herpetic super-infection of pre-existing
skin diseaseskin disease
Potentially life-threateningPotentially life-threatening
Early recognition vitalEarly recognition vital
Effective treatmentEffective treatment
Pre-existing skin diseasePre-existing skin diseaseand and
Acute Blistering?Acute Blistering?
ThinkThinkEczema HerpeticumEczema Herpeticum
ReferencesReferences Mackley C, Adams DR, Anderson B, Miller JJ. Eczema Mackley C, Adams DR, Anderson B, Miller JJ. Eczema
herpeticum: a dermatological emergency herpeticum: a dermatological emergency Dermatology NursingDermatology Nursing Oct 2002;14(5):307-10 Oct 2002;14(5):307-10
Wollenberg A, Zoch C et al. Predisposing factors and clinical Wollenberg A, Zoch C et al. Predisposing factors and clinical features of eczema herpeticum: a retrospective analysis of 100 features of eczema herpeticum: a retrospective analysis of 100 cases cases Journal of the American Academy of Dermatology Journal of the American Academy of Dermatology Aug Aug 2003;49(2):198-2052003;49(2):198-205
Buccolo LS. Severe rash after dermatitis Buccolo LS. Severe rash after dermatitis The Journal of Family The Journal of Family Practice Practice Aug 2004;53(8):Aug 2004;53(8):
Atherton DJ, Marshall WC. Eczema herpeticum. Atherton DJ, Marshall WC. Eczema herpeticum. PractitionerPractitioner 1982;226:971–973.1982;226:971–973.
Simon C, Everitt H, Kendrick T. Simon C, Everitt H, Kendrick T. Oxford Handbook of General Oxford Handbook of General Practice Practice 2nd ed. Oxford: Oxford University Press, 2005 2nd ed. Oxford: Oxford University Press, 2005