Eczema Herpeticum

Overview

Eczema herpeticum is a serious skin infection caused by the herpes simplex virus — the same virus that causes cold sores. It happens when the virus gets into skin that is already broken or inflamed by eczema (atopic dermatitis). It causes painful blisters and raw sores, often with fever and feeling unwell. It can become serious quickly, so it needs urgent medical care. It is treatable, especially when caught early.

It is uncommon. Most people with eczema will never get it, but because it can be serious, it is important to know the signs.

Anyone with eczema can get it, but it is most often seen in children and young adults with atopic dermatitis. It can also affect people whose immune system is weakened by illness or treatment. The cold sore virus can pass from person to person by direct skin contact, but eczema herpeticum itself is not passed from person to person.

Symptoms

Common symptoms

• Painful small blisters filled with clear fluid
• Blisters that burst and leave raw, red, small round sores that look like little holes
• Sores often in areas of eczema, but they can spread
• Fever
• Feeling tired or unwell, like having flu
• Swollen or tender glands
• Skin pain, burning or itching that is worse than usual
• A new rash that spreads

Symptoms in children

• Fever
• Being irritable, sleepy or hard to comfort
• Poor feeding or drinking
• Painful skin that may make them cry when touched
• New blisters or raw sores
• Fewer wet nappies or signs of dehydration

Symptoms in older adults

• Fever and feeling generally unwell
• Painful rash or blisters, sometimes on skin with long-standing eczema
• Confusion or drowsiness can be a warning sign in severe infection
• Dry mouth, dizziness or less urine than usual

Causes

Main causes

• Eczema herpeticum happens when herpes simplex virus — usually the cold sore virus — infects skin that is already damaged by eczema.
• The virus can enter through tiny cracks or broken areas in the skin.
• It is not caused by poor hygiene.

Risk factors

• Having atopic dermatitis (eczema), especially if it is active or severe
• Broken or cracked skin
• Close skin contact with someone who has a cold sore
• Having had the cold sore virus before
• A weakened immune system from illness or treatment
• Being a young child

When to see a doctor

See a doctor urgently if:

• You or your child has new painful blisters or raw sores on eczema
• There is fever with a painful skin rash
• The rash is spreading quickly
• There is eye redness, eye pain or blisters near the eye
• The person is not drinking or not passing urine
• The skin is getting more painful, swollen or has pus

Book a routine appointment if:

• Eczema that keeps flaring or is hard to control
• Advice on avoiding cold sore contact when you have eczema
• Questions about your eczema care plan

Diagnosis

A doctor can often suspect eczema herpeticum from the look of the skin and your history. Because it can be serious, they may start treatment before test results are back.

Tests that may be done

• A swab from a blister or sore may be sent to a lab to look for the virus.
• Blood tests may be done if you are very unwell.
• A skin specialist may be asked to see you.

What to expect at your appointment

You will likely be seen quickly. A clinician may ask about cold sores and eczema, check your temperature and hydration, and arrange follow-up. If you are very unwell, hospital care may be needed.

Treatment

Eczema herpeticum needs urgent medical treatment. The main treatment is prescription antiviral medicine started as soon as possible. Supportive care for pain, fever, hydration and skin helps. Most people improve with early treatment.

Self-care at home

• Take any prescribed medicine exactly as your clinician tells you.
• Rest and drink enough fluids.
• Keep the skin clean and handle it gently. Avoid scratching.
• Wash your hands often.
• Avoid touching a cold sore and do not share towels, cups or lip balm with someone who has one.
• Do not put new creams on the sores unless your clinician says to.
• Watch for worsening symptoms and get help early.

Medical treatments

Doctors use prescription antiviral medicines to fight the virus. If the skin also has a bacterial infection, they may prescribe antibiotics. Pain and fever can be managed with advice from a pharmacist or clinician. Severe cases may need hospital care with fluids and close monitoring. Treatment is tailored to your age, pregnancy status, immune system and how severe the infection is.

When is surgery considered?

Surgery is not usually needed. Rarely, a specialist may need to drain a large collection of pus or treat complications.

Living with this condition

After recovery, keep eczema well controlled with moisturizers and your usual care plan. Learn your early warning signs. Avoid close contact with cold sores. Keep follow-up appointments.

Lifestyle tips

• Use gentle skin care and moisturize regularly.
• Avoid known eczema triggers.
• Manage stress and get enough sleep.
• Wash hands often.
• Do not share towels, cups, utensils or lip balm during a cold sore.
• Keep nails short to reduce scratching.

Diet and exercise

No special diet prevents eczema herpeticum. Eating well and staying hydrated support recovery. Once you have recovered, regular exercise is fine. Avoid getting too hot, and wash sweat off gently to protect your skin.

Mental health and emotional wellbeing

It can be frightening for patients and families. Skin conditions can affect mood, sleep and confidence. Talk to your clinician if you feel anxious or low. If you have thoughts of harming yourself, seek crisis support or emergency help right away.

Prevention

Not always, but you can lower the risk. Keep eczema well controlled, avoid close contact with cold sores, wash your hands, do not share personal items, and get skin infections checked early.

Vaccines

There is no vaccine that prevents eczema herpeticum. A vaccine for cold sores is not available.

Screening programmes

There is no screening test. If you have eczema, watch for the warning signs, especially after contact with a cold sore.

Complications

If left untreated

• Spread of the virus to other areas of skin
• Bacterial skin infection
• Dehydration and poor feeding
• Eye infection if the sores are near the eye
• Severe illness affecting internal organs, which is rare
• Scarring

Long-term outlook

With early treatment, most people recover well. Some people may have scars or another episode, but knowing the signs helps you get help quickly. Eczema can be managed, and support is available.

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