Acute vesiculopapular rash in the setting of atopic dermatitis

Atopic dermatitis is a common entity encountered in clinical practice. A subgroup within the atopic dermatitis cohort may develop viral infection on skin lesions appearing as a vesiculopapular pattern. This process is termed eczema herpeticum and may pose a challenge to the clinician as it can appear similar to orthopoxvirus infections, most notably smallpox and monkeypox. Because these conditions are considered as potential bioterrorism threats, confirmatory testing via histological examination, viral culture, immunohistochemical staining or PCR is recommended. Additionally, antiviral therapy should be promptly initiated as eczema herpeticum can disseminate or become superinfected with bacterial species. Early recognition and good communication with pathology can reduce morbidity and confirm the disease process.