Definition of Eczema Herpeticum: Causes, Clinical Features, Symptoms, Diagnosis and Treatments

eczema herpeticum blisters

It is a rare skin condition that usually features rashes and several blisters filled with pus.

It is a condition that puts resistance to many kinds of first care. However, the application of topical corticosteroids can alleviate the skin.

In many cases the disease may worsen over time, that is why the diagnosis must be successful, from the beginning, to prevent the lesions from being exacerbated.

It can start with skin lesions in any part of the body. These blisters or rashes are as small water bullets, which burst and that results in fluid coming out. If you take precautions and get diagnosed, this could lead to a picture in which these lesions extend to other unaffected areas.

The clinical assessment of each patient “removes the mask” from the disease, for this we must go to the professionals specialized in herpetic eczema, and they are the dermatologists.

Since it occurs in erythema papules, which are forming plaques, you can also see small cysts that are painful, and cause quite itching and heat in the affected area.

There is no age to be attacked by herpetic eczema, but symptoms can be exaggerated in children, the elderly, and in people suffering from some allergy to the skin.


Eczema herpeticum is caused by the same virus that causes cold sores, the Herpes simplex virus HV1. Some virus related to this Herpes infection can also cause this particular kind of Eczema.

The disease typically affects those with ordinary (atopic) eczema (also known as atopic dermatitis), including children.

It can also occur where the skin has been damaged by burns or by some other skin diseases, such as ichthyosis, seborrheic dermatitis, and psoriasis.

Also called varicelliform Kaposi rash, it is an extensive and disseminated vesicular-pustular skin infection caused by the Herpes simplex virus in patients with atopic dermatitis as a complication of a herpes simplex located in them or their relatives.

Herpetic eczema is a disseminated viral infection, characterized by fever and the appearance of clusters of itchy blisters. Some often see it as a complication of atopic dermatitis/eczema.

What is the cause of herpetic eczema?

Most cases of herpetic eczema are due to herpes simplex virus type 1 or 2. It usually occurs during a first episode of herpes simplex (herpes) primary infections.

Signs appear between 5 and 12 days after contact with an infected person, who may or may not have a visible cold sore. Some people had stated that it could complicate recurrent herpes. However, repeated episodes of herpetic eczema are unusual.

It can also be related to other dermatoses, such as Darier’s disease, pemphigus, extensive seborrheic dermatitis, and psoriasis.

Anybody suffering eczema should avoid those with cold sores so that they don’t catch the virus. If your child has this disease, make sure they avoid contact with people with cold sores.

Adults with atopic dermatitis may become infected with the illness because their sexual partners transmitted the virus; so each person should tactfully explain the situation to potential partners before intimacy.

This condition affects men and women of all ages, but it is more frequent in babies and children with atopic dermatitis.

It can also occur when there are other reasons for the breakdown of the skin barrier, including:

  • Thermal burns
  • Pemphigus Vulgaris
  • Darier’s disease
  • Cutaneous T-cell lymphoma/mycosis fungoides
  • Ichthyosis

Clinical features

Herpetic eczema begins with clusters of blisters that itch and hurt. It can affect the flesh anywhere, but people often see it on the face and neck.

Blisters can appear on the healthy skin or in areas previously affected by atopic dermatitis or other skin diseases. The new patches are formed and spread over a period of 7 to 10 days and rarely spread throughout the body.

Usually, the patient is not well, presents fever and inflammation in the local lymph nodes.

  • The blisters are monomorphic, that is, they all look similar to each other.
  • They are likely filled with a light yellow liquid or thick purulent material.
  • Often they are stained with blood, that is, they acquire a red, purple or blackish color.
  • The new blisters have central dimples (umbilication).
  • They can drain or bleed.
  • The old blisters form crusts and sores.
  • The lesions heal in 2-6 weeks.

In severe cases where the infection heavily damages the skin to the point of nearly destroying it, small white scars form that can persist in the long term.

In these cases, a secondary bacterial infection by staphylococci or streptococci can lead to impetigo and cellulitis.

Severe herpetic eczema can affect multiple organs, including the eyes, brain, lungs, and liver. Despite this, it can rarely be fatal.

Eczema Herpeticum Symptoms

Blisters appear on the body and can spread over a large area. The lesions are often seen on the face or neck but may be elsewhere on the body. The blisters are itchy and contain pus.

A high temperature is usually noted, and the lymph nodes in the armpits may swell. The disease needs urgent medical treatment, particularly in young children. It is one of the few skin diseases that are genuinely life-threatening.

Incorrect diagnosis sometimes occurs. Doctors should carry out tests for the herpes simplex virus if eczema herpeticum is suspected.

A newspaper from health workers in Taiwan relates the case history of a young child who had her eczema herpeticum misdiagnosed as impetigo (a bacterial skin disease).

The child was treated with antibiotics, but her condition continued to deteriorate since antibiotics are ineffective against viral diseases. Eventually, a dermatologist made the correct diagnosis, which was confirmed by positive tests for the herpes simplex virus. The child was then treated with anti-viral drugs and recovered.


The diagnosis is clinical, but laboratory tests should confirm it. One of such methods could be the Tzanck’s smear test, which, although it is known to be non-specific, shows a cytopathic image that, when correlated with the clinic, is considered diagnostic. Medical experts can make cytodiagnosis by taking samples of the secretion of the blister, and with this substance, they can carry out a viral study.

The presence of IgM against herpes simplex virus type 1 indicates a herpetic primoinfection and high IgG values suggest endogenous reactivation; It is also common to observe elevated serum IgE levels. Complications include keratoconjunctivitis, secondary bacterial infection, fluid loss and viremia.

The treatment should be established as quickly as possible, even without waiting for culture results. Ideally, medical experts should provide such treatment as an intrahospital procedure so they can monitor the patient.

In intravenous infusion, acyclovir is administered at a dose of 40 mg/kg/day, as well as systemic antibiotics if there is superinfection; Also, palliative measures are provided to recover the cutaneous surface. Topical and systemic steroids are contraindicated


Healthcare providers need to deal with the disease as quickly as possible; in fact, their first move should be giving the patient anti-viral medicine.

They can give their patients Acyclovir tablets or syrup. Acyclovir (or aciclovir) is an established anti-viral drug, which proves to be an excellent mean to combat the Herpes simplex virus.

In very severe cases, some may require intravenous acyclovir. In such circumstances, doctors can also use Valacyclovir. The body metabolizes this drug to acyclovir in the body.

Foscarnet is another anti-viral drug sometimes used to treat Herpes simplex, particularly against strains of the virus resistant to acyclovir. Such resistant strains sometimes occur in immuno-compromised patients, such as those who have AIDS.

Steroid skin creams may be prescribed for atopic eczema and other skin conditions, but are ineffective against eczema herpeticum.

Secondary bacterial infections may occur with eczema herpeticum, and patients should get them treated with the appropriate antibiotics.

Reinfection can occur. Parents of children who had successfully overcome eczema herpeticum should continue to check for signs of the disease. Herpes simplex differs from most other viral infections, where those recovered from the condition nearly always have immunity from further attacks.

Untreated, eczema herpeticum can attack the eyes, eventually leading to blindness. An ophthalmologist should be consulted if the disease strikes the area around the eyes.

This type of eczema can be a fatal disease, particularly in young children or immuno-compromised patients, so prompt treatment is vital.

It is imperative that the evaluation of the diagnosis is known beforehand, to go directly to the cure, to the relief, and to the treatment, processes that must be punctual in each case.

That is why other factors, such as pre-existing diseases in patients, such as bronchial asthma, which often occurs in cases of herpetic eczema, clinical status, hydration, diet, etc., have to be seen.

It begins with some specific studies in laboratories, which must have the immediate results to rule out any other pathology, and the doctors must start with the appropriate treatment.

When it comes to these specific cases of herpetic eczema, there can be many reasons, but the most repeated, are the infections of the papules product of dermatosis undiagnosed in time, or in the cases that the person suffers from psoriasis, as well as some burns.

The rashes of herpetic eczema can all look alike. But these vesicles may become bleeding pustules that are quite painful, and if the patient is a minor, they will be noticeably altered while feeding or resting; most kids would be crying all the time, and quickly get tired, such fatigue and discomfort indicate the condition is getting worse, that is why you have to go immediately to the doctor.

We said that these papules become infected by bacteria and yeasts, which, although if they get treated at the right moment, they heal after two or three weeks, leaving many times some marks for life.