High frequency of detection of herpes simplex virus DNA in the oral cavity of patients with eczema herpeticum

BACKGROUND: It has been reported that herpes simplex virus (HSV) DNA was detected in the oral cavity of patients with herpes labialis under various conditions such as during oral surgery. OBJECTIVE: The frequency of detection of oral HSV DNA was compared between first or recurrent episodes of eczema herpeticum and recurrent type herpes labialis. PATIENTS AND METHODS: Oral swabs were collected from 7 patients with eczema herpeticum and 9 with herpes labialis. The detection of oral HSV DNA was performed by the polymerase chain reaction method. RESULTS: Oral HSV DNA was detected in 6 out of 7 patients (86%) with eczema herpeticum and 3 of 9 (33%) with herpes labialis. CONCLUSIONS: The high frequency of oral HSV DNA detection in eczema herpeticum suggests that subclinical herpetic lesions may develop in the oral cavity of patients with a first episode of eczema herpeticum or may occur during asymptomatic oral HSV shedding in people with recurrent eczema herpeticum.     

Eczema herpeticum: a dermatologic emergency

Eczema herpeticum is a potentially life-threatening herpetic superinfection of a pre-existing skin disease. Despite the availability of antiviral therapies, eczema herpeticum remains a dermatologic emergency today. Two representative cases of eczema herpeticum along with discussion of the etiology, means of diagnosis, treatments, and complications of eczema herpeticum are presented.     

Detection of Herpes simplex virus DNA in non-herpetic areas of patients with eczema herpeticum

BACKGROUND: Patients with atopic dermatitis may develop a widespread cutaneous herpes simplex virus (HSV) infection called eczema herpeticum. OBJECTIVE: We examined the possible routes of indirect HSV dissemination in 10 patients with eczema herpeticum, although direct spread of HSV is the most likely route of infection. METHODS: Specimens were collected from hands and 'non-herpetic' areas (i.e. without eczema herpeticum), with or without eczematous and/or erythematous lesions of atopic dermatitis, of 10 patients with eczema herpeticum. We tried to detect HSV DNA in the samples by polymerase chain reaction. RESULTS: HSV DNA was frequently detected on both hands and on cutaneous surfaces clinically free of eczema herpeticum. These patients had scratched such lesions because of itching. Moreover, they had taken baths the day before the examination. CONCLUSION: These results suggest that there may be two routes of indirect transmission of this virus, namely via manual scratching of herpetic lesions or via a contaminated bath towel or item of underwear.     

Immunological Studies of herpes simplex virus infection in children with atopic eczema

Summary This study examines the role of immune defence mechanisms in herpes simplex virus (HSV) infections in atopic eczema and whether impairment of these mechanisms explains the susceptibility of some children with atopic eczema to cutaneous HSV infections. Ten children with eczema herpeticum and 13 with atopic eczema and recurrent HSV infection affecting multiple skin sites were studied, together with relevant control groups. In all children with atopic eczema, in vitro lymphoproliferation in response to stimulation with concanavalin A (Con A) was significantly decreased and natural killer (NK) cells (CD16 + 56) were reduced compared with non-atopic controls. IL-2 receptors, a marker for lymphocyte activation, were decreased during the acute phase of eczema herpeticum, and for 1 month thereafter. A positive stimulation index (>3) to HSV antigen, and high HSV lgG antibody titres measured by ELISA. Western blotting and neutralization assay, were seen in children with eczema herpeticum by 6 weeks, and also in children with atopic eczema and recurrent HSV infections. No evidence of an HSV-specific immune defect (either cell-mediated or humoral) was found in atopic eczema. Impairment of cell-mediated immunity in atopic eczema and recurrent HSV infections. No evidence of an HSV-specific immune defect (either cell-mediated or humoral) was found in atopic eczema. Imairment of cell-mediated immunity in atopic eczema was suggested by the reduced response to Con A. It is likely that reduced numbers of circulating NK cells and a decrease in IL-2 receptors during early eczema herpeticum contribute to the susceptibility of children with atopic eczema to cutaneous HSV infections.     

疱疹性湿疹

报告1例疱疹性湿疹。患儿男,8个月,头面部出现水疱1周。既往有特应性皮炎病史。面颊部有密集出血性痂样皮损,单纯疱疹病毒（HSV）-I IgM（＋）。诊断：疱疹性湿疹。     

Topical Corticosteroids and Hospital Length of Stay in Children with Eczema Herpeticum

Abstract: There is concern that the use of topical corticosteroids in patients with eczema herpeticum may facilitate dissemination of herpes simplex virus and worsen disease. Our primary aim therefore was to determine whether topical corticosteroid use in children hospitalized with eczema herpeticum is associated with longer hospital length of stay (LOS). We performed a multicenter retrospective cohort study of 1,331 children ages 2 months to 17 years admitted with a diagnosis of eczema herpeticum between January 1, 2001, and March 31, 2010, to 42 tertiary care children’s hospitals in the Pediatric Health Information System database. Multivariable linear regression models determined the association between receipt of topical corticosteroid therapy on the first day of hospitalization and the main outcome measure: LOS. Receipt of topical corticosteroid therapy on day 1 of hospitalization was not associated with a longer LOS on unadjusted or multivariable analysis (p = 0.75). Receipt of topical calcineurin inhibitors during the hospitalization was also not associated with a longer LOS (p = 0.12). Receipt of systemic corticosteroids was associated with an 18% adjusted longer LOS (95% confidence interval 2%–36%; p = 0.03). Further study is needed to identify which children with eczema herpeticum may benefit from topical corticosteroids, but their use during active infection is not associated with poorer outcomes, although the use of systemic corticosteroids was associated with a longer LOS and should be avoided in patients with eczema herpeticum pending future prospective study.     

Atopic dermatitis and pox-virus superinfections (author's transl)

Subjects afflicted with atopic dermatitis are particularly predisposed to such viral superinfections as verruca, herpes (eczema herpeticum) and vaccinia (eczema vaccinatum). Knowledge of superinfection by the molluscum contagiosum virus is more recent and the authors describe one case. The orf virus (responsible for ovine ecthyma contagiosum), however, has never been described as responsible for the profuse superinfection of an atopic eczema. The authors observed one case of this in a child, atypical as result of his age (16 months), the cervical localization and the aspect, which was a telangiectasic granuloma type of the initial element, and finally of the satellization observed one week later. This child suffered from a generalized atopic eczema. Propagation of the orf lesions could have been favored by scratching, local corticoid treatment and by the deficit in cellular immunity observed in patient with atopic dermatitis. Indeed, viral superinfections, which are unusual by their profusion or their chronic nature, are often observed in immunodepressed subjects.     

Kaposi varicelliform eruption (eczema herpeticum)

A 35-year-old woman with a history of atopic diathesis presented to the emergency department with 2 weeks of widespread facial vesiculopustules and eroded vesicles. HSV-1 was found on viral culture and direct fluorescent antibody testing. She was diagnosed with eczema herpeticum, an uncommon and potentially life-threatening viral infection that arises in areas of pre-existing dermatosis. Antiviral treatment for eczema herpeticum is very effective, and should be instituted without delay to avoid significant morbidity and mortality.     

Psoriasis Herpeticum due to Varicella Zoster Virus: A Kaposi's Varicelliform Eruption in Erythrodermic Psoriasis

Kaposi's varicelliform eruption (KVE) or eczema herpeticum is characterized by disseminated papulovesicular eruption caused by a number of viruses like Herpes simplex virus I and II, Coxsackie virus, and Vaccinia and Small pox viruses in patients with pre-existing skin disease. The occurrence of KVE with psoriasis has been reported recently as a new entity psoriasis herpeticum. The rare causation of psoriasis herpeticum due to Varicella zoster virus in a patient with underlying psoriasis is being reported for the first time.     

Empiric Antibiotics and Outcomes of Children Hospitalized with Eczema Herpeticum

Abstract: Although patients with eczema herpeticum often receive antibiotics for presumed bacterial coinfection, the effect of empiric antibiotic therapy is unknown. Our objective therefore was to determine the association between empiric antibiotics and outcomes in children hospitalized with eczema herpeticum. We conducted a multicenter retrospective cohort study of 1,150 children ages 2 months to 17 years admitted with eczema herpeticum between January 1, 2001, and March 31, 2010, to 42 tertiary care children’s hospitals in the Pediatric Health Information System. All patients received antibiotics during the hospitalization. Multivariable linear regression models determined the association between empiric antibiotic therapy and the main outcome measure: hospital length of stay (LOS). There were no deaths during the study period. Receipt of empiric antibiotics was not associated with a change in the LOS on unadjusted or multivariable analysis. The class of empiric antibiotic was not associated with the LOS except for receipt of vancomycin, which was associated with a longer LOS (21% adjusted longer LOS, 95% confidence interval (CI) = 8–35%; p = 0.001). When restricted to patients with a bloodstream infection, receipt of empiric antibiotics was associated with a 51% adjusted shorter LOS (95% CI = ?24 to ?68%; p = 0.002). In children hospitalized with eczema herpeticum, empiric antibiotic therapy was not associated with a shorter LOS overall, but was associated with a shorter LOS in patients with a bloodstream infection. These findings highlight the importance of early recognition of systemic bacterial illness in children with eczema herpeticum. Empiric antibiotics did not affect mortality, which is low.     

Kaposi's varicelliform eruption: a case report and review of the literature

Disseminated herpes or vaccinia in the setting of underlying skin diseases is known as Kaposi's varicelliform eruption (KVE). Patients typically present with disseminated vesicopustules in the areas of the most severe involvement of their underlying skin disease. We report a case of eczema herpeticum in a woman with a long-standing history of atopic dermatitis (AD). This report also reviews the literature on eczema herpeticum and eczema vaccinatum (EV), summarizes clinical and histopathologic characteristics and treatment, and discusses the recommendations of the Centers for Disease Control and Prevention for smallpox vaccination.     

Treatment with acyclovir of genital herpes simplex virus infection complicated by eczema herpeticum.

Eczema herpeticum is a potentially serious disease that may be fatal. We report two cases of infection with genital herpes simplex virus (HSV) that were complicated by eczema herpeticum and were treated successfully with acyclovir.     

RECURRENT ECZEMA HERPETICUM ASSOCIATED WITH ICHTHYOSIS VULGARIS

Summary.— Two adult patients with both dominant ichthyosis vulgaris and a past history of atopic eczema, who developed recurrent attacks of eczema herpeticum, are described.     

Kaposi's varicelliform eruption

Kaposi's varicelliform eruption (eczema herpeticum) is the name given to a distinct cutaneous eruption caused by herpes simplex and certain other viruses that infect persons with preexisting dermatosis. Most commonly it is associated with atopic dermatitis. We report a case of a three-year-old atopic child who presented with extensive vesicular eruption suggestive of Kaposi's varicelliform eruption. There was history of fever, malaise and extensive vesicular eruptions. Diagnosis was made based on clinical features and Tzanck smear examination. Patient responded adequately to oral acyclovir therapy.     

Eczema herpeticatum

Patients affected by atopic dermatitis tend to develop viral infections. Probably the most feared complication of atopic dermatitis is eczema herpeticum, a disseminated infection with herpes simplex virus. A monomorphic eruption of dome-shaped blisters, pustules and erosions in the eczematous skin lesions along with severe systemic illness leads to the diagnosis. The clinical diagnosis may be confirmed by polymerase chain reaction, viral culture, electron microscopy with negative staining, Tzanck test, immunofluorescence tests or serology. While intravenous acyclovir is still regarded as standard treatment of eczema herpeticum, several recently-developed antiviral drugs provide therapeutic options.     

Eczema herpeticum in two elderly patients

Two elderly patients with eczema herpeticum are being reported. The First patient did not respond to the conventional dose of acyclovir. The second case was seen in a patient with air borne contact dermatitis.     

Punched‐out erosions with scalloped borders: Group A Streptococcal pustulosis

We present a case of an infant with severe atopic dermatitis infected with Streptococcus pyogenes who presented with pustules, honey‐colored crusts, and punched‐out erosions with scalloped borders mimicking eczema herpeticum or eczema coxsackium. We draw attention to this case to highlight the similar clinical appearance between bacterial and viral infections in the setting of atopic dermatitis and the importance of a broad workup and coverage while awaiting results.     

Acyclovir treatment of eczema herpeticum in Darier's disease

This paper describes two episodes of eczema herpeticum occurring in a woman with Darier's disease. During the first episode, the vesicular eruption represented a primary herpetic infection because there were no IgM herpes antibodies. The second attack suggested a recurrent infection. Herpes simplex, virus type I was isolated from the lesions in both cases.     

Eczema herpeticatum

Eczema herpeticum is an acute, disseminated herpes simplex virus infection which remains a feared complication of eczematous skin diseases, especially atopic dermatitis. The vesicular and erosive clinical picture is often accompanied by systemic signs and symptoms. Why some atopic patients experience multiple attacks of eczema herpeticum and others never have the disorder remains a mystery. Patients with severe or untreated atopic dermatitis are more likely to be affected. The pathogenesis appears to involve a complex interplay of factors, including demasking of binding sites for the virus through the dermatitis, failure to up-regulate antiviral proteins and a lack of plasmacytoid dendritic cells. Treatment of choice is systemic acyclovir therapy.     

Hailey-Hailey disease with dissemination and eczema herpeticatum in therapy with etretinate

We report a 39-year-old patient with Hailey-Hailey disease localized mainly in the genito-femoral and scrotal areas. During hospital treatment the condition worsened due to superinfection with Candida albicans and gram-negative bacteria. Treatment with systemic steroids followed by aromatic retinoids was tried: eczema herpeticum developed in the affected areas, and dissemination of Hailey-Hailey disease ultimately occurred with papulo-vesicular and histologically characteristic lesions.