By Gary M. White, MD
Wet, moist, acute, erosive dermatosis in an area of eczema.
Rapidly progressive, widespread crusted papules, vesicles and erosions in a child with atopic dermatitis is characteristic.
Many patients with atopic dermatitis will present with crusted lesions and the etiology--viral vs. staphylococcus--is impossible to determine without a culture. Thus, both viral and bacterial cultures are essential when vesicles are not apparent.
Patients with widespread or otherwise severe disease should receive intravenous acyclovir. Otherwise, oral acyclovir or one of the other antiviral agents is appropriate. See herpes simplex for dosing. Soaks BID can be helpful at removing crust. Topical steroid use during an outbreak did not slow healing in one study [Ped Dermatol 2013:30;215-21]. In terms of prevention, patients with atopic dermatitis should avoid close contact with patients with cold sores or other active herpes infection.
Herpes Simplex (duration 1 week so pustular) in a child with eczema (prurigo nodules shown here) that can lead to eczema herpeticum.
Psoriasis herpeticum: Kaposi's varicelliform eruption in psoriasis Dermatologica Sinica 33 (2015) 247-248
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