Eczema Herpeticum (extract from www.eczemaguide.com)

Eczema herpeticum – this is a term that I keep hearing of moms in forums sharing that their children have repeated eczema herpeticum during the year and also of delayed diagnosis where it’s not identified as herpeticum promptly.

If you search eczema herpeticum’s definition – you’ll see it’s often stated as a rare life-threatening complications that results from infections caused by herpes simplex virus type 1 or 2. The virus enters the child’s body through the defective skin (common in eczema children) and attacks multiple organs, including eyes, brain, lung and liver. However, judging from moms’ feedback, it isn’t that rare, so let’s learn more about it!

Is Eczema Herpeticum Dangerous?

Before we get to that, let’s look at how one gets it. Usually the child comes into contact or catches the virus from someone with cold sores. Cold sores is not dangerous and usually it causes blisters around the mouth and is accompanied with fever or flu-like symptoms. Cold sores is most contagious when there are blisters, but can also spread when there’s no blister as the herpes simplex virus can lie dormant in one’s body. The virus can be spread by kissing, sharing utensils, lip balm or generally, coming into contact with the mucus of the infected person.

Now, here’s the DANGER part – for a child with eczema, the herpes simplex virus can enter the skin and sets off a chain of infections, including large scale bacterial skin infection. The symptoms are:

1. 5-12 days after exposure – Rashes with blisters at eczema lesions/skin patches

2. Spreading of the blisters with yellow pus, accompanied with flu, fever and body aches

3. Blisters start to get painful with bleeding, scabbing

4. Widespread at body parts, usually neck, head, upper body with swollen lymph nodes

If left to run its course, the infections may take over body organs, including the eyes. Should the eczema on your child looks different than normal, and starts to blister with pus, it’s recommended to go to the hospital for a prompt diagnosis and treatment.

Diagnosing and Treating Eczema Herpeticum

Diagnosis can be quickly conducted by antibody staining of the pus filled vesticles or a viral culture test. Sometimes, it may be mistaken as small pox or chicken pox, but in any case, an anti-viral drug such as acyclovir or valaciclovir can be administered. For skin with bacterial infections caused by staph, antibiotics is also given to reduce the secondary infection risk.

Be prompt in going to hospital as research shows that the delay in one day increases hospital stay by 11% and one-third of the patients have staph infections, while 3.9% has blood infected and 3.8% needs to stay in intensive care.

As for why moms are sharing that their children gets repeated attacks, it’s because the virus stays in the child’s body and sometimes when there’s a trigger such as fever/flu or stress, it can set off the virus. Some children need to be on daily anti-viral drug which so far, seems to be minimal long-term negative effect as the drug attacks the virus but not the child.

Learn more about eczema and infection from National Eczema Society here.

Update on research in September 2015, Journal of Allergy and Clinical Immunology – Certain genetic variants in a gene (iFNGR1) have been studied to increase susceptibility of atopic dermatitis patients to eczema herpeticum.

Update on May 2017 article on Eczema Herpeticum written by MedicalNewsToday.com

A note on Marcie’s experience: When she got chickenpox, she didn’t get the anti-viral drug because her skin wasn’t so bad. When she got Hand-Foot-Mouth-Disease the second time, she was given anti-bacterial antibiotics because her skin looked red and infected.

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  1. Hi my son was recently treated for EH. He is 1 years old and I am so worried about myself and my other 2 kids getting it. What are the chances? May 13 he fell ill, may 15 he went to his doctor who said he had thrush. May 18 he went to the ER got admitted then was released for home care may 21st. He’s on the anti meds for 12 days since release. Thanks for any info

    1. Hi! Sorry to hear that your son has eczema herpeticum, hope he’s feeling better now.
      Eczema herpeticum is contagious, but the virus may not affect others in the same way as most with uncompromised immune system and normal skin get cold sores. But I’m not sure whether it is possible to spread to another family member, and then spread back again to the original family member who has eczema herpeticum.. It would be good to avoid sharing utensils, towels and not cough/ touch surfaces with mucus. Thus far from moderating eczema forums, I haven’t heard of people sharing that eczema herpeticum has spread (as eczema herpeticum) to another family member. Hope that your family stays safe, take care!

  2. Hey I was diagnosed with eczema herpeticum when I was 11 of course at the time I didn’t think anything of it because I didn’t know herpes was a life long disease. I’m just wondering if eczema herpeticum is contagious without outbreaks like regular herpes? Remind u I was 11 I never kissed anyone or had sex and when I got the infection it wasn’t on my mouth or genitals just my stomach back and neck

    1. Thanks for dropping by my blog 🙂 Think eczema herpeticum can spread through use of common use of towels or sharing cutlery/toothbrush with people who have cold sores, i.e. how virus normally spread. O.w. is not contagious (virus lies dormant) but avoid contact with newborn or people with suppressed immune system and children with eczema. The herpes simplex virus is different strain from that of sexually transmitted disease. Can find more info under British Association of Dermatologists site, have a good day!
      http://www.bad.org.uk/shared/get-file.ashx?id=197&itemtype=document

  3. My 17yr old son and wrestler who has suffered eczema since he was a new born recently attended a 2 wrestling camps out of state. When he arrived to the 2nd camp his eczema was more itchy than usual and then the blisters started to appear on his arms. He got diagnosed with impetigo and given antibiotics, 1 day later he came home and took him to ER and they double up on antibiotics thinking it was MRSA .
    Two days later back to ER since he kept on getting worse. They did cultures for heroes and staph and started him on antivirus acyclovir 5 times a day. In 2 more days the rash was all over his arms, upper torso, neck, face and around the eyes w 101.5 fever. He was hospitalized 4 nights and 5 days and discharged. He was with IV acyclovir 3 nights and when no new rashes were erupting switched to oral acyclovir and stayed another day. We are home and he is treating the burning open hives w aquafor. Are there more suggestions for healing the many sessions close together? Keeping in mind to not activate his eczema. How long does it take to get better from the rash?

    1. Hi LC, sorry to hear of the many sessions together.. I don’t know how to speed up the recovery though. Did the doctor mention anything about not spreading lotion from affected areas to non-affected ones? That was something I learnt after my kid had chickox – that moisturizing though good for eczema is not ideal for healing of chicken pox within certain days as it may be spreading the pus around. Don’t share towels, come into contact with people with cold sores (I joined a martial arts gym previously and was surprised how many people continue to do contact sports and use the gym towels even when they have cold sores), cleaning the skin to reduce staph bacteria may help to reduce likelihood of secondary infection. Am so sorry again to hear of the delay.. it’s common that eczema herpeticum gets misdiagnosed as impetigo as the rashes look the same, speedy recovery and you get some rest too!
      Hugs,
      Mei

      1. Thanks for the article.

        I’m 16 years old and recently went to China for 1 month where it is winter and I believe the air is dry. I have the symptoms of dry scaly skin behind my knees. Blisters have now formed in that area and also a increasing amount of blisters all over my leg.

        I started with a cold sore on the bottom of my lip which after the whole month has still not gone away. In fact it has now grown to 3 cold sores on the bottom lip and 2 on the top lip. however I’m not sure whether it is a cold sore or eczema on the lips.

        On my face I have a grown red patch which oozes yellow pus which drips over my face. It looked like impetigo to me. I went to to doctor to get this checked and for some reason he gave me Pevisone cream. I came home and used it twice a day, once at night and once in the morning. After the first night it stoped oozing and was not as red. In 3 days the whole red patch had cleared up. I was delighted! However a few days later light blistersts with yellow crusts on top started forming on the same area. I thought nothing or it as it was not that big yet. The next day the blisters could not be seen as it was fully covered a yellow layer which looked like honey. I was shocked! So I did some research and it still looked a lot like impetigo to me. I used fucidin ointment on the area and after 3 days it was not as red and not oozing however it is still there and growing starting just on my cheek to pea sized crusts on my forehead, eyebrows and temple area.

        With all these symptoms I went to the doctor who gave me levocetirizine hydrochloride tablets taken once every night, qingre sanjie jiaonang 3 times a day and 6 pills each time and also a pink paste to be used on the blisters and red patches to prevent itching.
        After 4 days my symptoms seem to be getting worse. Some of the blisters have now turned into red patches varying in size which oozes and is painful to touch. The blisters and spreading and after waking up yesterday, I found that it had developed all over my back. I’m am getting very worried that these blisters will turn into the red painful patches on my leg. The blisters have also formed on my arms and body.

        I’m not sure weather I have impetigo or eczema or eczema herpiticum. I haven’t had a fever but the patches look like eczema herpiticum. I’m leaving China in 3 days but am worried the patches will grow all over my body. The Chinese doctors also seem to only work for profit as he did not even ask any questions on my visit and prescribed the medicines in two minutes without seeming worried.

        If anyone has any ideas I would be happy to hear them.

        1. Sorry to hear of the problem – blister could be many other skin conditions, not necessarily impetigo/eczema/herpeticum.
          In China, depending on the city you’re in, you can see doctors from clinic that cater to foreigners.
          Not sure about the prescription creams that you’ve been given.. any chance of getting hold of some chlorhexidine gluconate wash?

          The last time when my daughter had impetigo, we used that twice a week for body wash.

          Take care,
          Mei

    2. I am so sorry to hear this lots of rest and washing hands keep anti bacterial hand wipes at hand wipe everytime he touches his skin i know they are itchy from my experience so keep nails short and clean. All the best and he will get through it x

  4. Hi I am a long suffer of eczema over 47 years comes and goes in stages, but recently had a rash look like bite marks but left holes in the skin which become itchy and sore pleas can you u tell me what it is? Its driving me crazy

    1. Hi Kathy, so sorry to hear of your rash. I don’t know what it is, but I’m (wild) guessing that it may not be eczema if the itch and rash is distinctly different from what you’re used to. Maybe check to see if it’s scabies? Take care!

  5. Hi my son is 6 now wgen he was a baby he suffered from eczema when he was 6 month I took him to hospital with what looked like water blisters on the bk of his head they had the yellow pus and they burst and reappeared the hospital sent mehome sayin it was just his eczema! ! My son now suffers every week with impetigo could this be anything to do with the eczema?? Im at my wits end with it and no answers

  6. My 19 month old was diagnosed yesterday with Eczema Herpeticum. Never heard of it before now. I really thought he had hand foot mouth disease. He has had eczema since 6 months old and his right (dominant) hand has always been bad and tends to stay scabby or open sore during flare ups. I knew something wasn’t right when the eczema took on a raised bumpy blister look on his hands and most of the outbreak was in his usual eczema flare up areas. He seemed perfectly normal other than the rash. (He had a high fever two days before but made a quick recovery. The rash appeared within 24 hours of the fever stopping.) Luckily his pediatrician recognized it on the first visit the minute he walked into the room. I am very pleased and blessed to have such a great doctor from what I have heard on these other posts! He has been practicing for at least 10 years and has only seen this infection 3x. My son started anti-virals yesterday so I hope he doesn’t experience any side effects or relapses. My other son who is 7 just developed a cold sore yesterday afternoon so I guess he also has the virus though I am praying he doesn’t develop the infection as he also has a history of eczema.

    1. Thanks for your sharing and I’m so glad for you that your doctor could diagnose it fast. Be very careful about not sharing towels, utensil, and kisses!.. and possibly protect your child’s skin. The more scratched skin, the more likely the virus (if come into contact) can enter. I came across a recent research that there’s genetic variant that makes one who has eczema more likely to have herpeticum. Hopefully, your other son doesn’t have that, big hugs and thanks loads for your sharing, real glad for the early diagnosis.

  7. If your child is born with eczema, DO NOT let anyone kiss him/ her, especially if you see they have a cold sore or blister around their mouth or face. Pediatricians should really warn parents of children with eczema of the danger in contracting eczema herpeticum especially with babies born with eczema.
    My son was born with eczema and would constantly scratch. We found out it was eczema when he was about 4 months old. He was put on steroids and Vaseline.

    At six months old he contracted HSV1 from someone who had a cold sore. This person had no idea of the danger it posed to our child. He lovingly kissed the baby on the neck and in a few days; the baby had a severe outbreak with oozing blisters around his neck, growing within hours to his face. It was terrible. Luckily our pediatrician sent him to the ER right away. Our baby was hospitalized for 10 days. The doctors were worried the herpes infection had reached his bloodstream, but thankfully the infection did not reach his bloodstream or vital organs.

    This baby is now a 3 year old toddler whose eczema has gotten better, but still has herpes outbreaks whenever he has a cold or is in the sun or heat. He is currently recovering from an outbreak that started last week but thankfully no hospital stay. 2 months ago however, he was in the hospital for this issue for 4 days. Going through this experience with our son, we are very keen to anything appearing on his skin and when we see something on his skin that we are not sure it’s a staph infection that can be controlled by antibiotics, we take him right away to the dermatologist.

    The danger is that if the herpes outbreak occurs around the face and especially close to the eyes it can cause blindness.

    Parents, if you see that your child has some sort of blister or hive or weird rash and are not sure if it’s a staph infection (which eczema children are prone to) please take them to the doctor right away as a herpes outbreak grows really quickly and can reach vital organs. It spreads within minutes. My son is now on vale acyclovir and doctors are considering putting him on a longer term dosage as a preventative.
    His dad and I have researched foods that can help prevent outbreaks and we found that lemon balm tea can help prevent outbreaks as well as certain foods.

    Here are some links for reference, but always consult your child’s doctor first with any diet or supplement questions!

    http://www.sandiegohomeopathy.com/downloads/Lysine_Arginine_Foods.pdf

    http://justherpes.com/facts/foods-to-avoid-with-herpes-diet/

    http://www.livestrong.com/article/277660-foods-to-eat-that-help-heal-prevent-a-herpes-outbreak/

    May your little one be healthy and strong and may you as parents find the strength and guidance you need to help your little one.

    Love, Ana

    1. Thanks Ana for sharing, and yes you’re right about checking our child’s skin – we realized too with ours, that we’ve become a bit of an expert. When the rash don’t look the same, it usually isn’t. We had our share of impetigo and shingles + many more probably not diagnosed cos she gets weird rash when someone in her preschool falls sick.

      Thanks for taking the time to share!
      Mei

  8. I’m glad you have this website. It is comforting to read other people’s stories. My 4 year old daughter was just diagnosed with this. She had cold sores in the past year which were mild and only occurred 2 -3 times a year. She gets eczema in the summer months (we live on the East Coast) and it usually starts around end of May and goes through October. She typically gets the eczema the fingers of her left hand (her dominant hand) and the back of her legs and thighs.

    Over the last few weeks we noticed her hands were very raw from the eczema and she was getting blisters. Then a week ago I saw a small patch of tiny bumps in a circular cluster on her leg which I thought was eczema and so I applied a topical eczema cream.

    The next day it crusted and looked like the cold sores she gets, but on her skin in a large swath. We have a ongoing prescription of topical Acyclovir that we keep on standby for when she gets her oral cold sores. We applied that and saw our pediatrician. Within a day we saw both our pedi and a dermatologist. Both didn’t seem overly concerned, inspected the blisters on her leg and hands, and prescribed the oral acyclovir and advised us to let it run its course. It seemed to be contained. They also advised us that she could go back to preschool.

    After a week her hands still seem sore, her leg is healing but still looks raw and red as it heals. She recently got a bump in her chin, which looks like a large pimple. I’m not sure if this is another sore or a side effect. Possibly impetigo?

    We’ve decided to hold her out from preschool until we can get a grasp on what is to come. We are trying to listen and trust our doctors, but also be proactive parents so we can try to contain this. II’d love to know more about how people have been living with this and what has been successful treatment. Are there any specialists that people have seen? It seems like such a rare medical thing. Arming ourselves with as much information as possible is all we can do at this point to help ease our worries.

    Thanks for your time,

    Sincerely,

    Kevin

    1. Hi Kevin,

      Thanks for dropping by! I have a daughter too and she’s got shingles, impetigo, chicken pox, HFMD, countless times of swollen finger bacterial infections from finger biting (so much that my husband is now an expert in draining the pus himself instead of heading to the emergency ward!).

      Some thoughts on active management of eczema – perhaps allergy test to see if there’s pollen allergy since she gets eczema during certain months OR could be like my daughter who gets eczema when she’s sweating and out in the hot sun. We carry towels with us to wet and clean off the sweat after outdoor play and then moisturize (if we can’t head back home that is, ow we promptly shower her after she’s out and sweaty). The sweat residue can irritate skin, esp when it’s dried, so maybe take care to keep cool and fresh all the time.

      My daughter has eczema on her dominant hand too, and we think it’s contact dermatitis to the coloring pen. Never tested for that but we suspect cos only her dominant hand gets it. Perhaps moisturize her hand so that it acts as a layer of protection against the pen. Or could be friction against the paper when writing. Friction is also a trigger for rash.

      Does your child’s rash look like
      http://eczemablues.com/2014/07/eczema-news-impetigo-for-eczema-child/

      I also use chlorhexidine-based shower on my child twice weekly, same effect as bleach bath, basically is to kill the staph bacteria which is the cause of many infections/complications in eczema kids. It also makes the eczema much harder to heal.

      Eczema is not rare, affects 20% of kids. What I think is important though is to see experienced doctors as some can’t identify the complication of eczema, for instance, I diagnosed my kid’s rash as impetigo but 3 other young docs gave 3 different diagnosis before a senior doctor said it’s impetigo. Their diagnosis range from scabies to fungus! Also an experienced doc can recognise sooner than inexperienced ones when the treatment requires change. Esp for steroid cream, if it’s not working, you can’t keep putting more of it due to side effect.

      The doctor should be working proactively to identify triggers and pre-empt future flare-up, so I’m totally in agreement that you ought to find a specialist. Esp for girls, (am I sexist?) but untreated eczema with scratching leaves permanent scarring, it’s not pretty.

      Take care Kevin and hope I’m of some help,
      Mei

      1. Thanks Mei,

        I should’ve also clarified that she was “diagnosed” with eczema herpeticum. I use quotations only because it was not the typical outbreak associated with eczema herpeticum. Instead of widespread circles all over the body that spread like wildfire, what she got was small blisters clustered in an area on her leg and fingers. She was on Acyclovir for a few days and when we stopped the liquid a small blister/impetigo appeared on her chin. Everything has been scabbing and looks to be healing. The fingers are difficult because it’s her dominant hand, so it’s impossible trying to convince a 4 year old to stop picking or using her hand. We’ve been using winter gloves to help protect it while it gets better.

        We saw a children’s dermatologist yesterday who was very comforting and explained that it could technically be classified as herpeticum, but that it was a very mild case with no complications or fever and we could expect it to run its course. It will likely reoccur, but were told it would likely be less severe. It didn’t seem to cause him any concern. It helped alleviate our worries a lot.

        We plan to be more proactive going forward with treating her eczema before it gets bad. We’ve been moisturizing her often, especially after out door play. I’m very curious about the pollen allergy, as the eczema flares do get worse when the pollen index rises.

        Anyhow, thanks very much Mei. I’ll look forward to checking in on the blog often and sharing.

        1. Thanks Kevin and so glad to hear that your session with the dermatologist went well. Be careful about sharing towels and keep her clear from anyone with cold sores. I always run like crazy (with my kid of course!) when we see someone with cold sores cos we know she’s at higher risk of getting it. Take care and hear from you soon!
          Mei