Eczema herpeticum: Symptoms, diagnosis, and treatment

When the skin of someone with eczema comes into contact with the herpes virus, they may develop eczema herpeticum.

Eczema herpeticum is rare, but it can produce severe symptoms that need urgent medical attention.

In this article, we provide an overview of eczema and herpes and look at the causes, symptoms, and treatment of eczema herpeticum, which can occur when these two conditions meet.

Herpes does not cause serious health problems for someone with a healthy immune system. However, if a person with eczema becomes infected with one of the herpes simplex viruses — HSV-1 or HSV-2 — they may develop eczema herpeticum.

Eczema herpeticum is a rare but potentially serious complication. It can happen when areas of the skin that eczema affects come into contact with the herpes virus.

It is most likely to result from contact with a cold sore (HSV-1) and usually occurs on the:

head
neck
trunk

Symptoms of eczema herpeticum usually appear 5–12 days after exposure to sores from the herpes virus. The symptoms typically present as follows:

A cold sore may be an initial symptom.
A blistering rash can appear over 7–10 days. The blisters form a cluster and may cover a large area. They may break open, be itchy or painful, weep, bleed, or have pus or yellow fluid inside.
The person may feel unwell, with swollen lymph nodes, a fever, chills, and fatigue starting as the rash appears.

Eczema herpeticum is a medical emergency because it can lead to severe and sometimes life threatening complications, such as:

herpetic keratitis, an infection in the cornea of the eye that can lead to vision loss without treatment
organ failure and death, if the virus spreads to the brain, lungs, and liver
long-term scarring

Eczema herpeticum can occur in people with any condition or injury that involves damaged skin, such as:

contact dermatitis
burns
seborrheic dermatitis

Those most at risk are:

young children and infants
people whose eczema is severe or developed at an early age
those with a weakened immune system
a person with eczema who has undergone a skin peel, dermabrasion, or other cosmetic procedure
those with eczema who have sustained an injury to the skin

Eczema is a rash that causes dry, irritated, red, and itchy patches of skin. In most cases, eczema refers to atopic dermatitis, an allergic reaction that affects the skin.

Eczema may go through periods of remission and flares. During remission, the symptoms disappear, but during a flare, they worsen.

To reduce the risk of an eczema flare, a person may need to avoid certain triggers. Triggers vary among individuals, but they may include:

certain detergents
fragrances
some fabrics
metals, for example, in watch straps and jewelry
stress
specific foods or ingredients
other irritants or allergens

Eczema is often bothersome, but it does not usually cause serious complications.

Most eczema flares heal without long-term problems. However, exposure to the herpes simplex virus can lead to severe and possibly life threatening complications.

Most people refer to herpes simplex viruses as "herpes." These viruses transmit from one person to another and can cause painful or itchy blisters or open sores.

When sores or blisters appear, this is called a herpes outbreak. Many people have herpes but do not have symptoms or outbreaks, so they are unaware that they have the virus.

There are several types of herpes, but the two common ones are herpes simplex virus types 1 and 2.

Herpes simplex virus type 1 (HSV-1)

HSV-1 commonly causes cold sores, known as oral herpes. HSV-1 is very contagious.

According to the World Health Organization (WHO), about 67% of people under the age of 50 have HSV-1, globally.

HSV-1 can spread through sexual contact from the mouth to the genitals, but it is not necessarily a sexually transmitted infection (STI). Many people get HSV-1 through nonsexual contact, including kissing or sharing personal items, such as lip balm or utensils.

Herpes simplex virus type 2 (HSV-2)

HSV-2 spreads through sexual contact with a person who has the infection. It can cause blisters in the genital area, known as genital herpes.

It can also pass from a woman to a baby during childbirth if the woman has the infection. About 11% of people around the world have HSV-2.

Treatment for HSV

There is no cure for HSV-1 or HSV-2 infection. Once a person has one of these viruses, it will stay in their body for life.

A person with herpes is more likely to spread it to others when blisters are present. However, herpes can still spread to another person when there are no symptoms.

Antiviral medications cannot cure a person of the herpes infection, but they can reduce the frequency and severity of herpes outbreaks. They can also reduce the chances of it spreading from person to person, but they cannot eliminate the risk.

A doctor can usually recognize eczema herpeticum by looking at the symptoms. However, it can sometimes be difficult to distinguish the condition from an eczema flare.

To confirm a diagnosis, the doctor may take a swab from a blister to check for bacteria or a virus.

Although a virus causes herpes, if the area becomes exposed to bacteria, a bacterial infection can also be present. When this occurs, it is called a secondary infection.

To treat eczema herpeticum, a doctor will likely prescribe an antiviral medication, usually in the form of tablets or syrup. They will often also recommend continuing any ongoing eczema treatment. The person may also need to take antibiotics if a secondary infection develops.

Some people with eczema herpeticum may need to spend time in the hospital.

If symptoms worsen quickly, the person may need urgent medical treatment. If there are signs of infection in the eye, they will need to see an ophthalmologist, often urgently, as herpes in the eye can lead to blindness.

Early treatment can help prevent complications and stop HSV from spreading to vital organs.

Any blisters that have formed may take 2–4 weeks to heal. They do not usually leave scars unless people pick or scratch them.

The best way to prevent eczema herpeticum is to manage the symptoms of eczema and take measures to avoid HSV-1 and HSV-2.

People can do this by:

Identifying eczema triggers: Avoid them whenever possible.
Moisturizing the skin after bathing and throughout the day, as necessary: Avoid scratching the skin, as this may cause cracks or breaks that leave it vulnerable to infections.
Using eczema medications as the doctor prescribes: These may be oral or in the form of creams for the skin.
Keeping track of eczema symptoms: Always see a doctor if they worsen.
Avoiding catching a cold sore: Do not kiss people with active cold sores or share drinks, utensils, or personal items with them.
Protecting affected skin: Wash the hands frequently, and avoid touching areas that eczema affects, whenever possible.
Being open with sex partners about STIs: Undergo regular STI testing, and ask sexual partners whether they have had a test for genital herpes and other STIs.
Using a latex condom during sex: A condom acts as a barrier against STIs, including herpes.
Limiting contact with people who have an active HSV infection: People with an active infection should limit contact with young children and those with a weakened immune system or atopic eczema.

People should seek medical attention if a blistery rash appears on the skin, especially if other symptoms, such as a fever, are present.

Parents or caregivers of infants and young children should talk to a pediatrician about the best way to manage the child's eczema symptoms and seek medical advice if blisters appear.

Managing eczema can minimize discomfort and improve quality of life, but it can also help prevent a serious skin infection.

Keeping the skin healthy and unbroken helps protect the body from unwanted viruses and bacteria that can cause illness.

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