But you may not be aware of one particularly dangerous trigger: the virus that causes cold sores, the herpes simplex virus (HSV). Direct contact with another person’s cold sore, especially when eczema symptoms are flaring, can lead to a very serious complication called eczema herpeticum. Infants and children with moderate to severe eczema are most susceptible to this skin infection, but eczema herpeticum can also affect adults, says the American Academy of Dermatology (AAD). The condition isn’t common. Research suggests that less than 3 percent of people with eczema will develop eczema herpeticum, according to a review published in August 2020 in the journal Clinical Reviews in Allergy & Immunology. However, it can be life-threatening, especially if the infection spreads over wide areas of skin or involves organs, such as the brain, lungs, or liver, says the National Eczema Association (NEA). For this reason, it is vital for people with eczema and parents of children with eczema to understand how to prevent an infection with HSV, as well as how to recognize symptoms of eczema herpeticum as soon as they arise, in order to seek prompt medical treatment.
What Is Eczema Herpeticum?
Eczema herpeticum is a painful, blistery rash that occurs when eczema-damaged skin is infected with herpes simplex virus type 1 (HSV-1) through skin-to-skin contact, says the NEA. The most common symptom of HSV-1 is a cold sore on the lip or around the mouth that takes a week or two to heal. Occasionally, HSV-1 can cause genital herpes, often through oral-genital contact, according to the Centers for Disease Control and Prevention (CDC). Although not typical, another herpes simplex virus, HSV-2, which causes most cases of genital herpes, can also trigger eczema herpeticum. “Patients with eczema have a compromised skin barrier that puts them at a higher risk of skin infections in general, including eczema herpeticum,” says Nika Finelt, MD, director of pediatric dermatology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in New Hyde Park, New York. Eczema causes breaks in the skin, which allows the herpes virus in. In kids and young adults with eczema, wrestling and other contact sports can increase the risk of coming into direct contact with the herpes simplex virus and developing eczema herpeticum. People who have other conditions that cause cracking in the skin’s surface, such as contact dermatitis or seborrheic dermatitis, can also develop eczema herpeticum, notes the NEA. Once the herpes virus gains a foothold, the infection can spread rapidly over the body, affect vital organs, and even become life-threatening, says Carol Cheng, MD, a pediatric dermatologist at UCLA Health in Santa Monica. Because of this, eczema herpeticum is considered a medical emergency. RELATED: Atopic Dermatitis Complications: What You Need to Know
How to Spot Early Symptoms of Eczema Herpeticum
The first signs of eczema herpeticum occur about 5 to 12 days after exposure to HSV, says the AAD. At that point, it can be easy to think that changes in the skin are simply a particularly bad flare-up of eczema. However, symptoms of eczema herpeticum — which include painful red, purple, or black blisters — tend to be more dramatic in appearance than eczema, says the NEA. These blisters typically occur on the face and neck, but they can appear anywhere on the body where there is eczema and the skin has been in contact with the herpes virus. In addition to a painful, blistery rash, eczema herpeticum can cause more general body-wide effects, says Sruthi Renati, MD, an assistant professor of dermatology at the University of Michigan–Michigan Medicine in Ann Arbor. “Some patients develop high fevers, a general feeling of discomfort or feeling unwell, and enlarged lymph nodes,” she explains. These symptoms often start as the blisters are appearing. Due to the potential for severe complications, you should call your doctor or dermatologist right away if you or a family member who has eczema develop any of the following symptoms:
A cluster of small, itchy, painful blistersBlisters that are around the same size and have a punched-out look (like a hole puncher was used across the affected skin)Blisters that are red, purple, or blackCrust that forms over older blistersBlisters that ooze pus when brokenA cold sore above the upper lipHigh fever and chillsSwollen lymph glandsNot feeling well overall
How Is Eczema Herpeticum Diagnosed?
Often, a doctor can diagnose eczema herpeticum through a physical evaluation, says the NEA. A physician may also take a sample of skin scraped from the infected area (also known as a smear) to confirm the diagnosis. The smear is sent to a lab to be examined under a microscope, says the AAD.
How Is Eczema Herpeticum Treated?
Eczema herpeticum is typically treated with antiviral medications, such as acyclovir (Zovirax), which work by stopping the herpes virus from spreading inside the body, says the AAD. Because early treatment is best, your doctor may begin this medication even before a lab confirms the diagnosis. Depending on the severity of the infection, these drugs may need to be given in a hospital through an intravenous line into the bloodstream, says Dr. Finelt. “The patient may also need IV hydration and may need to be treated for a secondary bacterial infection [with an antibiotic],” she adds. Topical medication may be used to treat the eczema as well. Usually patients start to see improvement within a few days and can have a complete resolution of symptoms within a few weeks, although this can vary depending on how severe the condition is when it is diagnosed and treated.
Potential Complications of Eczema Herpeticum
It’s important to seek care for eczema herpeticum as soon as possible to prevent complications. “If untreated, eczema herpeticum can be associated with a secondary bacterial infection, often with staph aureus,” Dr. Cheng says. This type of infection can be severe and may require hospitalization and treatment with intravenous antibiotics. It’s also possible for the virus to spread to the eye, leading to a condition called herpetic keratitis, which can cause scarring of the cornea, vision loss, and even blindness, says the American Academy of Ophthalmology. To avoid this complication, “patients with lesions on the face near or on the eyelids may require an ophthalmology consult,” says Cheng. In rare cases, eczema herpeticum can spread to the brain and spinal cord. “In children, infants, and people with a compromised immune system, and in severe cases, there is a risk of developing meningitis, which is inflammation of the brain and spinal cord, and encephalitis, which is inflammation of the brain,” says Dr. Renati. Eczema herpeticum can also lead to organ failure and death, but this is extremely rare. A study published in February 2018 in the Journal of Investigative Dermatology examined the health records of 4,655 pediatric patients hospitalized with eczema herpeticum and found that the mortality rate was 0.1 percent.
5 Ways to Reduce Your Risk of Eczema Herpeticum
If you or one of your family members has eczema, you can help reduce the risk of developing eczema herpeticum by following (and teaching your children to follow) these protective measures. Additional reporting by Ashley Welch.
