Fifteen-minute consultation: eczema herpeticum in a child

Eczema herpeticum (EH) occurs when there is secondary skin infection with herpes simplex virus in an atopic patient. The patient may not have unusually severe or active eczema. It is thought that the abnormal skin barrier function predisposes to infection, which can spread rapidly. Viraemia and secondary septicaemia can occur, and the condition can be life-threatening. The first episode of herpes infection is usually the worst and requires systemic treatment. Early recognition is vital. The presentation may be difficult to distinguish from secondary bacterial infection, which is common in eczema. A useful clinical clue is the presence of many very similar shaped and sized eroded lesions. Intact blisters may not be seen due to scratching. A rapid deterioration in eczema in a child who is systemically unwell should prompt consideration of EH.