Here’s Dr. Kendall with today’s Morning Report!
ECZEMA HERPETICUM
(Kaposi varicelliform eruption)
Distinct cutaneous eruption caused by virus on existing dermatosis
Virus (HSV-1, HSV-2, coxsackievirus A16, vaccinia virus)
+
Dermatosis (atopic dermatitis, seborrheic dermatitis, SLE, psoriasis, etc.)
HSV + ATOPIC DERMATITIS (main combination)
PATHOPHYSIOLOGY
Cell mediated immunity: T helper type1/T helper type 2 imbalace?
Humoral immunity: High IgE levels?
Skin barrier dysfunction
HSV is for life
EPIDEMIOLOGY
Incidence increasing (more HSV)
Mortality decreasing 50% → 10% (IV Acyclovir)
All ages
PRESENTATION
Sudden eruption, painful vesicles
Umbilicated vesiculopustules → punched out erosions
Spreads for 1 week → Resolves in 2-6 weeks
Diff dx: chickenpox, impetigo, contact dermatitis, chronic bullous disease
BADNESS
Fever, malaise, lymphadenopathy
Viremia (liver, lungs, CNS, GI, adrenal)
Secondary Infection → Septicemia
Keratoconjunctivitis
ED MANAGEMENT
Acyclovir
Abx?
Ophtho? (herpetic keratitis)
Work-up? (viral culture, DFA, Tzanck, PCR, biopsy…Derm?)
Admit severe infections and immunocompromised
Jay Khadpe MD
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