Doctor Q&A Youtube EczemaBlues Channel

AAD A:Z Videos with Dr Daniela Kroshinsky – Cold Sores

In 2013, I’ve featured American Academy of Dermatology (AAD)’s Dermatology A: Z Videos (here). Since then, AAD has added several other videos which are informative and practical. AAD’s public relations team has once again been most helpful in introducing me to the dermatologists who assisted with my questions, making it possible to bring this special AAD Dermatology A:Z video series to you!

The video covered today is “How to Treat Cold Sores”. For this video, I interviewed Dr. Daniela Kroshinsky M.D., MPH, who is an Associate Professor of dermatology at Harvard Medical School in Boston and the director of pediatric dermatology and director of inpatient dermatology, education, and research at Massachusetts General Hospital.

MarcieMom: Thank you Dr Daniela for helping us with treatment of cold sores this week (and last week’s interview on pain management in shingles). For parents with eczema kids, we’re very vigilant about cold sores because of the risk of eczema herpeticum. We are looking forward to learn more about limiting the spread of cold sores at home and how to minimize the likelihood of eczema herpeticum.

Key points in the AAD Video

  • Half of population carry the cold sore herpes simplex virus (HSV)
  • Symptoms of cold sores – Burning, itching or tingling, small blisters on the lips or around the mouth which may merge, burst and crust over
  • Triggers of cold sores – stress, fatigue, flu/fever, sun exposure, hormonal changes, trauma (shaving cuts, cosmetic surgery)
  • Treatment – Apply topical anti-viral cream to slow the reproduction of the virus, cool the sores at home with a cool wet towel
  • Reduce pain by taking aspirin and ibuprofen
  • Avoid acidic fruits, such as tomatoes and citric fruits that can irritate the open skin
  • Anti-viral medication used within 72 hours of rash appearing may shorten the period of cold sores or be used for prevention for those with recurrent cold sores
  • Highly contagious – avoid kissing, sharing towel, cups, shavers, toothbrush or any other object that come into contact with the cold sores
Questions answered by Dr Daniela Kroshinsky on How to Treat Cold Sores
Questions answered by Dr Daniela Kroshinsky on How to Treat Cold Sores

MarcieMom: Dr Daniela, cold sores are quite common but often, the people getting cold sores may not be aware of the severity of spreading to someone, for instance to a young child or to a person with severe eczema.

How contagious is cold sore? For instance, is my child safe as long as she doesn’t share anything with or touch the person with cold sore? Or is it super contagious? (The minute I see someone with cold sore, say in a train, I would leave the cabin. I imagine that he could have touched his cold sores, hold on to the train handle, and if I touch that or somewhere else in the train cabin that has contact with the cold sore, I would get it and possibly pass on to my child with eczema!) Is hand-washing sufficient to get rid of the cold sore virus? (Does anti-microbial product kill the virus or high temperature?)

Dr Daniela: The virus that causes cold sores spreads by direct contact so someone with a cold sore in the same cabin as a person with eczema would not pose a risk.  Spread through shared items depends on if and how much bister or wound fluid could be transmitted. Usually this is very unlikely to take place in public spaces.  In general, it’s a good idea not to touch strange fluids on trains! Handwashing and antimicrobial products would help to minimize this risk.

MarcieMom: I read on Mayo Clinic that the first-time getting the cold sore tend to be more serious that subsequent outbreaks; often, first-time cold sores may be accompanied by:

  • Fever
  • Painful eroded gums
  • Sore throat
  • Headache
  • Muscle aches
  • Swollen lymph nodes
  • Cold sores inside their mouths (for children under age 5)

Is each cold sore outbreak due to the same virus and therefore, there’s increased immunity with each outbreak? Will cold sores affect young children differently?

Dr Daniela: The first outbreak tends to be more severe with each subsequent outbreak being less involved.  Just like the varicella virus of chickenpox can lie dormant in a nerve root and then cause shingles, the cold sore virus, herpes simplex, can lie dormant and reactivate.  Children are less likely to be affected by cold sores but most people have been exposed to the virus by the time they reach adulthoods.

MarcieMom: For someone with severe eczema, the herpes simplex virus can infect compromised skin causing  eczema herpeticum. Dr Daniela, what are the factors that increase the likelihood of someone with eczema getting eczema herpeticum from cold sores? Is any child with eczema at higher risk or is he/she at higher risk only if the eczema is severe or generalized over the whole body?

Dr Daniela: Close contact with caregivers who are prone to cold sores can increase the risk of transmission of the virus.  Uncontrolled eczema leads to increased risk of open skin that could facilitate the virus spreading to the areas that are affected by eczema.  This can happen with any open area but would be more likely depending on how extensive the eczema is and as a result how much of the skin barrier has been compromised. 

MarcieMom: There are many parents whose eczema kids keep getting repeated episodes of eczema herpeticum. Apart from being on long-term anti-viral medication, are there other measures a child can take to reduce the likelihood of getting recurrent cold sores/eczema herpeticum?

Dr Daniella: Eczema herpeticum is the general term for when eczema is infected by herpes simplex virus, regardless of cause.  The best thing to do to minimize risk is to keep the eczema well-controlled and well-hydrated, minimizing dry or open patches that could allow the virus to enter more readily.

Thank you Dr Daniela for being so patient with these questions on cold sores and bearing with me (a paranoid mom!) and my questions on eczema herpeticum. We have learnt much from you and understand better the preventive measures to take to limit the spread of cold sores.

News & Research

Eczema News – Herpeticum for Atopic Child?

Has Eczema Herpeticum recur for your child?
Has Eczema Herpeticum recur for your child?

Eczema herpeticum has been covered in this blog before, and for the past few months, there seem to be more parents contacting me or commenting on this topic. There are a few key questions, with the main one being whether a child with eczema/atopic dermatitis is more susceptible to eczema herpeticum and whether once a child gets it, he/she will keep getting it. Let’s look into research in this area:

Quick Basics of Eczema Herpeticum

Eczema herpeticum happens when a patient with eczema gets infected with the herpes simplex virus, the same virus responsible for cold sores. Symptoms of eczema herpeticum are painful, rapidly worsening eczema with blisters, sores, accompanied by fever. A child can get the virus from sharing towel or in general, coming into contact with the mucus of someone who has the virus (who may not necessarily have the cold sores/ herpeticum).

Treatment includes anti-viral medication, oral acyclovir. In view of how fast the drug can work to control the herpeticum in conjunction with the increasing length of hospital stay when not treated fast enough, it is usually advisable to administer acyclovir expediently (see article here, here and here).

Are Children with Eczema/ Atopic Dermatitis more prone to Eczema Herpeticum?

Yes, generally due to the defective skin barrier and lower immune system, eczema kids ‘catch’ skin infection much easier. This article suggest that those with skin inflammation that is uncontrolled are more likely to get eczema herpeticum. Other possible hypothesis of eczema kids getting herpeticum involve the gene, gene expression, filaggrinhistory of food allergy/asthma and early onset of AD.

Will Eczema Herpeticum Recur?

Yes, and it is also possible to get secondary bacterial infection, i.e. from Staph aureus bacteria. For more on staph, see here. I’ve found a study (on mice) that noted the mice infected with staph bacteria get higher penetration of the herpes virus. More on herpeticum here.


It is quite often heard of delayed administration of the anti-viral drug because of misdiagnosis, being confused with impetigo. Anti-bacterial drug will not treat herpeticum and delayed treatment can severely affect the body, leading to blindness (keratoconjunctivitis) and death. Hospitalization was required for half of the patients, and those who are hospitalized had a higher likelihood of recurrence (article here).

Share your experience in this post, esp. when studies in this area is difficult to conduct, experiences may just help!

Photo Credit: NIAID via Compfight cc

Living with Eczema

SOMEONE Manages Eczema Herpeticum

Jenny with severe facial eczema
Jenny shares on her eczema herpeticum experience

This is a series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Jenny who is sharing about her eczema herpeticum experience. Jenny blogs about her own personal experiences with eczema at i-have-eczema. She also has a lovely blog at Little Jenny Wren on her crafts, cakes and fashion.

Marcie Mom: Hi Jenny, thanks for sharing about your eczema herpeticum experience. Let’s start with you sharing a little of eczema history.

Jenny: Hi Mei! Thanks for having me! Eczema only became a problem for me in my mid-teen years when I became a lot more exposed to environmental allergens. Since this time it has become very widespread affecting every part of my body except my nose, fingers and feet. As a child I suffered more so from asthma and hay fever but as an adult I suffer with severe eczema. 

Marcie Mom: When did your eczema herpeticum occur and what happened before and during treatment? (an archived post on Eczema Herpeticum – What is it and is it dangerous?)

Jenny: Since April 2012 I’ve contracted Eczema Herpeticum 7 times. Eczema Herpeticum is when the herpes simplex virus presents itself in an eczema sufferer, but instead of getting a cold sore or two, the virus spreads rapidly through areas that are affected by eczema. This can be an extremely dangerous condition, especially if not treated swiftly, as it can go on to affect organs and even cause septicemia and other life-threatening conditions.

My most recent outbreak is the worst I’ve ever experienced. It started in my eyes as a mild itch that I put down to being possible conjunctivitis. However over the course of the day the typical warning signs of eczema herpeticum became apparent as the cold sore-like vesicles presented themselves. It became so bad that I couldn’t even open my eyes. I also went on to develop a secondary infection of Periorbital Cellulitis so required emergency medical help. I then went on to spend 6 days in hospital being treated through an IV drip. It was pretty frightening as when I’ve suffered with eczema herpeticum in the past a dosage of Aciclovir tablets have been able to sort me out… but not this time.

Jenny on Eczema Herpeticum

Marcie Mom: Is there any medication and follow-up consultation required?

Jenny: In my case because I’ve contracted this virus so often, I am on a near-permanent course of Aciclovir tablets in order to keep it at bay. Most people would only require enough medication to treat the initial outbreak as it is uncommon for it to prevail as it has for me. I also see a dermatologist at the very least of once a month to ensure my skin is in good control.

Marcie Mom: One final question – what would be your biggest take-away from this experience?

Jenny: In all honesty I’m not sure how to answer this question. I’m now at a stage where I’m terrified that it will happen again to the extremity that I ended up hospitalised. It has only been a week since I was discharged after all. I guess in order to overcome it I need to get my immune system into a workable order as it is when you are run down and stressed that the herpes simplex virus breaks out. As an aside note, I have been taking immunosuppressants to control my severe eczema for a few years now and so these will not be helping to treat my immune system. If possible I would suggest to take eczema through the natural route to try to stop your immune system from getting into this state as mine has.

I’ll also add that I was never affected with the herpes simplex virus until I met my current partner who periodically suffers from cold sores. I never in my wildest dreams expected it to manifest in me as it has. Cold sores are such a common contagious infection that can be spread through something simple such as sharing towels and touching things that the infected person has touched. They’re pretty hard to escape from so always practise good hand hygiene where possible.

Marcie Mom: Thank you so much for sharing your eczema herpeticum journey, quite a few children had it too and parents reading this would have gained some insight.

Eczema Facts

Eczema Herpeticum – What is it and is it dangerous?

Eczema Herpeticum (extract from

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

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.

Support Group

Eczema meets Chickenpox

My girl, two year old, just passed the 14 days medical certificate required for chickenpox. With some sanity finally restored in the house, I could post a short account of what happened.

Before the 1st Day of Chickenpox

Actually, her pre-school already had a round of toddlers getting chickenpox and the teachers thought Marcie’s tiny red spots somewhat resembled what the other kids got. I took her to the doctor and he said it’s eczema and not chickenpox. To me, she normally didn’t have so many tiny red spots but it clearly didn’t look like chickenpox. Here’s her picture during this period.

Marcie posing under a christmas tree in a mall (and I’m surprised she knew how to pose!)

First 3 Days of Chickenpox

About 15 days later, we noticed her high fever and red spots clearly didn’t look normal. Brought her to doctor and confirmed chickenpox. Though she had fever, felt very hot at night, she managed to retain her good spirits and appetite. The chickenpox started on her face and neck.

Next 7 Days of Chickenpox

These were the days when it got worse – the chickenpox itch and the eczema itch. Parts of her skin which normally were fine started becoming dry, peeling and turning reddish – brought back memories when her eczema was severe. The chickenpox spread to the whole body and we had to cool her down by letting her play in the indoor playpool. I think most people don’t bathe and limit spreading lotion/water from one part of the body to the other, but with Marcie, we bathed and moisturized her as usual. We did apply calamine lotion and gave her anti-itch syrup from doctor.

Frog Play Pool

After 14 Days

This is a picture of her, finally able to go out, happily playing with a number-block book while waiting for her noodles!

Finally! There’re pox scars everywhere but as long as it’s not itchy, I’m glad.