| disease | Eczema Herpeticum |
| alias | Eczema Herpeticum, Coxsackie Eczema, Kaposi's Varicelliform Eruption, Vaccinia Eczema |
Eczema Herpeticum was first described by Kaposi in 1845 and is also known as Kaposi's varicelliform eruption, eczema vaccinatum, and eczema coxsackium.
bubble_chart Etiology
Sudden onset in infants and young children with eczema, atopic dermatitis, or impetigo caused by herpes simplex virus or vaccinia virus. Viral inclusions caused by herpes simplex virus are seen in the nucleus on cell smears, while those caused by vaccinia virus are observed in the cytoplasm.
bubble_chart Clinical Manifestations
It mostly occurs in children under 5 years old but can also be seen in adults. After infection with the herpes simplex virus, there is an incubation period of about 5–9 days, followed by sudden high fever (39–40°C), general malaise, nausea, vomiting, drowsiness, and other toxic symptoms. The rash begins on the face, neck, upper limbs, and trunk, often in areas with pre-existing skin diseases, but can also appear on normal skin. The lower limbs are rarely affected. Characteristics of the rash include worsening of pre-existing rashes, sudden appearance of numerous clustered blisters that quickly turn into pustules with umbilicated tops and marked redness at the base. Sometimes the rashes merge into large patches. After 1–2 weeks, the rashes dry and form crusts, leaving behind pigmentation and superficial scars. Nearby lymph nodes may swell. Complications can include pharyngitis, tonsillitis, rhinitis, otitis media, conjunctivitis, keratitis or corneal ulcers, pneumonia, and encephalitis.
bubble_chart Auxiliary Examination
1. Blood routine test shows leukopenia.
2. Tzanck cytology examination reveals multinucleated giant cells in the base smear of the blister.
3. Histopathology shows intraepidermal or subepidermal vesicles or pustules, with reticular degeneration and ballooning degeneration, often with multinucleated epithelial cells. The dermis exhibits significant inflammatory cell infiltration, predominantly neutrophils.1. Diagnosis Based on a history of herpes simplex contact and clinical features, the presence of multiple umbilicated vesicles and pustules on pre-existing eczematous skin accompanied by systemic symptoms can lead to diagnosis.
2. Differential Diagnosis
(1) Eczema Vaccinatum This condition has a history of smallpox vaccination. Histopathological examination reveals vaccinia virus inclusion bodies in the cytoplasm of basal layer cells.
(2) Chickenpox Systemic symptoms before the rash are mild, and there is no pre-existing eczema or similar rash.
(3) Smallpox There is a history of pestilence epidemic, no history of pre-existing eczema, severe systemic symptoms, and dense umbilicated pustules.
(4) Impetigo The pustules are superficial, easily rupture to form honey-yellow crusts, are not umbilicated, and lack systemic symptoms.
bubble_chart Treatment Measures
1. Children with skin diseases such as eczema or atopic dermatitis should avoid contact with patients infected with herpes simplex.
2. Isolate promptly after onset, rest in bed, drink plenty of water, and consume nutritious, easily digestible food. Strengthen nursing care.
3. Systemic and local treatments can be the same as those for herpes simplex. For severe cases, gamma globulin can be administered intramuscularly at 3–6 mL per dose, once daily or every other day.
