Eczema Herpeticum?

Q: What causes eczema herpeticum, how can flare-ups be prevented, and is there a vaccine?

A: There is no vaccine. Eczema herpeticum is basically a herpes simplex infection that is a little bit out of control. It is very common within the first few years of life; kids get herpes infections then for the first time. Often-times it’s inside the mouth and then it gets reactivated on the lip, as do cold sores, in association with upper respiratory infections, for example. So children who have eczema are at increased risk for having that sort of thing develop and become quite extensive. Sometimes multiple areas are affected at the same time, and it is very often in areas where there’s active eczema or a history of some eczema in the past. Fortunately it’s very treatable. We treat it most commonly in children with something called acyclovir. There are some other cousins of that that can be used if resistance develops, particularly in older adults. The biggest problem is recognition. You have to recognize that it’s not infection from bacteria, but in fact is from a herpes simplex virus infection. There’s new information coming out that helps us understand what causes this. Particular chemicals being made in the skin, correlating with increased severity of eczema, increases the risk of having other types of infection. For those who have recurrence issues with eczema herpeticum, it’s really important to recognize that prophylactic therapy is not a big deal. Acyclovir is a pretty safe medicine that really targets the virus and does protect humans. There may be a rash, there may be some side effects, but they are pretty few and far between.

So for individuals who have recurrent eczema herpeticum, if it’s three or more times a year, I’m really going to consider recommending prophylaxis once a day, and then I’ll reevaluate that personally. And I do that at six-month intervals and decide whether it’s time to stop and see how things go. Others should at least have it at home so that if it comes up very quickly, the individual can be treated.

Excerpted from the Ask-the-Experts Session, 2010 NEA Conference