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[A man with severe skin rash].

T V Nguyen1, G L van Rooijen, M B A van Doorn

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Summary
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A man with atopic eczema experienced a severe flare-up, diagnosed as eczema herpeticum. Prompt treatment with intravenous acyclovir and flucloxacillin was initiated.

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Area of Science:

  • Dermatology
  • Infectious Diseases

Background:

  • Atopic eczema is a chronic inflammatory skin condition.
  • Ciclosporin is an immunosuppressive medication used for moderate to severe eczema.
  • Eczema herpeticum is a serious skin infection complicating eczema.

Observation:

  • A 31-year-old male presented with acute onset of vesicles, crusts, and eyelid swelling superimposed on his chronic atopic eczema.
  • Physical examination revealed widespread erythematous papules, vesicles, erosions, and crusts, predominantly on the trunk and neck.
  • The patient had been on ciclosporin for four months with prior good control of his eczema.

Findings:

  • The patient was diagnosed with eczema herpeticum, a viral infection of the skin.
  • The presentation indicated a severe cutaneous viral infection in an immunocompromised host.

Implications:

  • Early recognition and aggressive treatment of eczema herpeticum are crucial to prevent complications.
  • Intravenous antiviral therapy (aciclovir) and antibiotics (flucloxacillin) are standard management for this condition.
  • This case highlights the importance of monitoring for secondary infections in patients with atopic eczema on immunosuppressive therapy.