The clinical spectrum and therapeutic challenge of eczema herpeticum.
We present 5 cases of eczema herpeticum in patients with severe recalcitrant atopic dermatitis to illustrate the range of possible clinical findings and supporting laboratory data that can obscure the diagnosis and complicate treatment. Major issues include: the need for aggressive laboratory evaluation (molecular diagnostics, viral cultures, skin biopsy, serology); the possibility of recurrent or chronic infection; the value of empiric antiviral therapy; the possibility of infection with thymidine-kinase resistant strains; and the importance of achieving control over the dermatitis with nonmyelosuppressive immunomodulating agents such as intravenous immunoglobulin or interferon gamma for dermatitis that requires systemic treatment.
Department of Pediatrics and Dermatology, Saint Louis University School of Medicine, Saint Louis, Missouri 63104, USA.
Stephanie
S
Frisch
Elaine C
EC
Siegfried
D015075:2-Aminopurine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000212:Acyclovir / Q000627:therapeutic use; D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D000077595:Famciclovir; D005260:Female; D006561:Herpes Simplex / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007371:Interferon-gamma / Q000627:therapeutic use; D007617:Kaposi Varicelliform Eruption / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D010328:Patch Tests; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D015075:2-Aminopurine; D007371:Interferon-gamma; D000077595:Famciclovir; D000212:Acyclovir; D008727:Methotrexate